Provider Demographics
NPI:1265986368
Name:WALSH, MELISSA (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:AMICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:39 CINEMA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3290
Mailing Address - Country:US
Mailing Address - Phone:978-466-6677
Mailing Address - Fax:978-466-1133
Practice Address - Street 1:39 CINEMA BLVD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3290
Practice Address - Country:US
Practice Address - Phone:978-466-6677
Practice Address - Fax:978-466-1133
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist