Individual
MELISSA BEDFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5676 W LAKE RD, BURT, NY 14028-9727
(716) 417-3609
Mailing address
5676 W LAKE RD, BURT, NY 14028-9727
(716) 417-3609
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
005485-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005485-1
STATE LICENSE
NY
Enumeration date
12/23/2016
Last updated
12/23/2016
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