Provider Demographics
NPI:1225244932
Name:BROWN, MELISSA GILBERT (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GILBERT
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 N MARBLE TOP RD
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-2037
Mailing Address - Country:US
Mailing Address - Phone:706-375-6482
Mailing Address - Fax:
Practice Address - Street 1:1501 RIVERSIDE DR
Practice Address - Street 2:STE 270
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-4309
Practice Address - Country:US
Practice Address - Phone:423-778-3196
Practice Address - Fax:423-778-6197
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003603225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant