Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE005407L | PA |
NPI | 1003068693 |
---|---|
Provider Name | Melissa M Ide |
First Address | Easton, PA 18045-5540 |
Second Address | Easton, PA 18045-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 15/10/2008 |