Provider Demographics
NPI:1104885599
Name:MELE, CHRISTOPHER LEE (MS, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:MELE
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ZIMMER RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1109
Mailing Address - Country:US
Mailing Address - Phone:860-413-3578
Mailing Address - Fax:
Practice Address - Street 1:1339 TOLLAND TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06041-0001
Practice Address - Country:US
Practice Address - Phone:860-647-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010712255A2300X
CT0004892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer