Provider Demographics
NPI:1023028958
Name:BUFFER, MELISSA GAYLE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:GAYLE
Last Name:BUFFER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 MASSACHUSETTS AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3329
Mailing Address - Country:US
Mailing Address - Phone:503-678-9806
Mailing Address - Fax:
Practice Address - Street 1:763 MASSACHUSETTS AVE STE 7
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3329
Practice Address - Country:US
Practice Address - Phone:503-678-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist