Provider Demographics
NPI:1992322135
Name:PIERETH, MELANIE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PIERETH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 DURBAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07843-1017
Mailing Address - Country:US
Mailing Address - Phone:973-398-8805
Mailing Address - Fax:
Practice Address - Street 1:616 DURBAN AVE
Practice Address - Street 2:
Practice Address - City:HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07843-1017
Practice Address - Country:US
Practice Address - Phone:908-797-1817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00913200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist