Provider Demographics
NPI:1386629343
Name:BOW, MELISSA CHRISTINE (PT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CHRISTINE
Last Name:BOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 COURT ST
Mailing Address - Street 2:RPT PHYSICAL THERAPY PC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4335
Mailing Address - Country:US
Mailing Address - Phone:718-855-1543
Mailing Address - Fax:718-855-0893
Practice Address - Street 1:335 COURT ST
Practice Address - Street 2:RPT PHYSICAL THERAPY PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4335
Practice Address - Country:US
Practice Address - Phone:718-855-1543
Practice Address - Fax:718-855-0893
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009531225100000X
NY029888-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8406266Medicaid
WA8406266Medicaid