Provider Demographics
NPI:1790938629
Name:BROOKS, MELANIE MARSHALL (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MARSHALL
Last Name:BROOKS
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 1:77 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4405
Mailing Address - Country:US
Mailing Address - Phone:415-317-1594
Mailing Address - Fax:
Practice Address - Street 1:3727 BUCHANAN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123
Practice Address - Country:US
Practice Address - Phone:415-593-2532
Practice Address - Fax:415-593-7974
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID24472251X0800X
CAPT343112251X0800X
MA21165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist