Individual
MRS. MELISSA IVY DIAMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1430 BROADWAY, LONG ISLAND CITY, NY 11106-4530
(718) 545-7095
Mailing address
1430 BROADWAY, LONG ISLAND CITY, NY 11106-4530
(718) 545-7095
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
023906-1
NY
Other
Enumeration date
03/26/2012
Last updated
03/26/2012
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