Individual
DR. MELISSA W THIBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
201 DATES DR, SUITE 201, ITHACA, NY 14850-1345
(607) 277-4097
(607) 277-4142
Mailing address
202 TAUGHANNOCK BLVD, PO BOX 366, ITHACA, NY 14850-3328
(607) 277-3257
(607) 277-4056
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
232165
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02552894
—
NY
Enumeration date
08/29/2005
Last updated
11/13/2008
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