MEDICARE: MRS. MELISSA BERTOLOZZI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	025213-1	NY

General Provider Information

NPI Number	:	1730169228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA BERTOLOZZI PT

Provider Business Mailing Address
First Line	:	45 EASTDALE AVE NORTH SUITE 102
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-1796
Country	:	US
Telephone Number	:	845-495-3070
Fax Number	:	845-495-3069

Provider Business Practice Location Address
First Line	:	45 EASTDALE AVE NORTH SUITE 102
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-1796
Country	:	US
Telephone Number	:	845-495-3070
Fax Number	:	845-495-3069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	11/22/2023

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