Provider Demographics
NPI:1437362050
Name:ATKINS, MELISSA MARIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:MARIE
Last Name:ATKINS
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 1:61 KEENE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1746
Mailing Address - Country:US
Mailing Address - Phone:508-326-1124
Mailing Address - Fax:
Practice Address - Street 1:61 KEENE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1746
Practice Address - Country:US
Practice Address - Phone:508-326-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7778225200000X
FLPTA 20657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant