Provider Demographics
NPI:1730169228
Name:BERTOLOZZI, MELISSA (PT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BERTOLOZZI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EASTDALE AVE NORTH SUITE 102
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1796
Mailing Address - Country:US
Mailing Address - Phone:845-495-3070
Mailing Address - Fax:845-495-3069
Practice Address - Street 1:45 EASTDALE AVE NORTH SUITE 102
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1796
Practice Address - Country:US
Practice Address - Phone:845-495-3070
Practice Address - Fax:845-495-3069
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025213-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist