Provider Demographics
NPI:1710135017
Name:GAGNE, MELISSA (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GAGNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PHILBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:200 ROUTE 108
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1119
Mailing Address - Country:US
Mailing Address - Phone:603-742-7492
Mailing Address - Fax:603-742-6762
Practice Address - Street 1:7 MARSH BROOK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-6523
Practice Address - Country:US
Practice Address - Phone:603-749-6686
Practice Address - Fax:603-750-3174
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3355225100000X
MA19004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist