Provider Demographics
NPI:1962084012
Name:MELANIE GRENALD MCDONALD PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:MELANIE GRENALD MCDONALD PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:GRENALD
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-400-5201
Mailing Address - Street 1:13921 85TH DR APT 4G
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2752
Mailing Address - Country:US
Mailing Address - Phone:347-400-5201
Mailing Address - Fax:
Practice Address - Street 1:19 W 21ST ST RM 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6877
Practice Address - Country:US
Practice Address - Phone:347-400-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy