Provider Demographics
NPI:1992071831
Name:BATALLA, MELISSA ANNE ARIAS
Entity type:Individual
Prefix:MS
First Name:MELISSA ANNE
Middle Name:ARIAS
Last Name:BATALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12610 BEDELL ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3141
Mailing Address - Country:US
Mailing Address - Phone:718-276-8785
Mailing Address - Fax:
Practice Address - Street 1:12610 BEDELL ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3141
Practice Address - Country:US
Practice Address - Phone:718-276-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist