Provider Demographics
NPI:1700156395
Name:BRO, MELISSA A (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BRO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 43RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:1905 INGERSOLL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3305
Practice Address - Country:US
Practice Address - Phone:515-369-2306
Practice Address - Fax:515-369-2307
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA004898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist