1356644777 NPI number — MELANIE ISABELLE ROSABELLA L.M.T

Table of content: MELANIE ISABELLE ROSABELLA L.M.T (NPI 1356644777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356644777 NPI number — MELANIE ISABELLE ROSABELLA L.M.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSABELLA
Provider First Name:
MELANIE
Provider Middle Name:
ISABELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MODJESKA
Provider Other First Name:
MELANIE
Provider Other Middle Name:
ISABELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.T
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356644777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28750 TRAILS EDGE BLVD UNIT 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONITA SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34134-7534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-514-3892
Provider Business Mailing Address Fax Number:
239-236-0647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24850 OLD HIGHWAY 41 ROAD
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-947-3900
Provider Business Practice Location Address Fax Number:
239-236-0647
Provider Enumeration Date:
12/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  7242372 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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