Individual
MARY MELILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
307 NOONAN DR, PACIFIC, MO 63069-1118
(636) 271-9995
Mailing address
3233 HIGHWAY F, DEFIANCE, MO 63341-1213
(636) 828-6012
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R0963
LICENSE #
MO
Enumeration date
08/30/2006
Last updated
07/08/2007
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