Provider Demographics
NPI:1487997276
Name:MCGLOUN, MELISSA S (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:MCGLOUN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5111 W GENESEE ST
Mailing Address - Street 2:MELISSA'S HEALING HANDS
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2357
Mailing Address - Country:US
Mailing Address - Phone:315-418-2353
Mailing Address - Fax:
Practice Address - Street 1:2605 BREWERTON RD
Practice Address - Street 2:A TOUCH ABOVE
Practice Address - City:MATTYDALE
Practice Address - State:NY
Practice Address - Zip Code:13211
Practice Address - Country:US
Practice Address - Phone:315-455-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY027048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist