Provider Demographics
NPI:1730147349
Name:PRAG, MELISSA LARA (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LARA
Last Name:PRAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LARA
Other - Last Name:PORTNOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:545 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6046
Mailing Address - Country:US
Mailing Address - Phone:401-475-5775
Mailing Address - Fax:781-828-7951
Practice Address - Street 1:545 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6046
Practice Address - Country:US
Practice Address - Phone:401-475-5775
Practice Address - Fax:781-828-7951
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02125225100000X
MA9543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist