Individual
MYRTZ MELODY REVESENCIO SEVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
160 BEACH 99TH ST, ROCKAWAY PARK, NY 11694-2807
(916) 513-3907
Mailing address
160 BEACH 99TH ST, ROCKAWAY PARK, NY 11694-2807
(916) 513-3907
Taxonomy
Speciality
Code
Description
License number
State
2251H1200X
Hand Physical Therapist
Primary
24692
MA
Other
Enumeration date
04/21/2020
Last updated
04/22/2020
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