| Doctor Name: | MRS. MELISSA MARIE WILLIS |
| NPI Number: | 1932352689 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSPT |
| License Number: | 018504-1 |
| Business Practice Address: | 309 Ruhle Rd S Ballston Lake, NY - 120191031 |
| Business Phone Number: | 5188992956 |
| Business Fax Number: | 5188992956 |
| Mailing Address: | 309 Ruhle Rd S, BALLSTON LAKE |
| State: | NY |
| Postal Code: | 120191031 |
| Phone Number: | 5188992956 |
| Fax Number: | 5188992956 |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 10/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 018504-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |