Provider Demographics
NPI:1811321961
Name:MELLI, JEREMY NEIL (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:NEIL
Last Name:MELLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2121
Mailing Address - Country:US
Mailing Address - Phone:609-536-4995
Mailing Address - Fax:
Practice Address - Street 1:3806 BAYSHORE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3208
Practice Address - Country:US
Practice Address - Phone:609-536-4995
Practice Address - Fax:609-939-0342
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01508500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist