| NPI | 1730147349 |
|---|---|
| Former Name | MELISSA LARA PORTNOY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT02125) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 9543) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2008-09-29 |