MEDICARE: MELISSA LYNN VIRGILIO PTA

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	225200000X	Physical Therapy Assistant	011866-1	NY

General Provider Information

NPI Number	:	1780146613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYNN VIRGILIO PTA

Provider Business Mailing Address
First Line	:	1328 MOLL ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2230
Country	:	US
Telephone Number	:	716-743-8077
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 MAIN ST STE 2
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-5313
Country	:	US
Telephone Number	:	716-692-6388
Fax Number	:	716-692-1227

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	04/01/2019

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