Provider Demographics
NPI:1427148980
Name:DE LEON, MELINDA ANNE (RPT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANNE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CAPRICORN LN
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-5112
Mailing Address - Country:US
Mailing Address - Phone:917-582-4396
Mailing Address - Fax:
Practice Address - Street 1:38 CAPRICORN LN
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-5112
Practice Address - Country:US
Practice Address - Phone:917-582-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist