Provider Demographics
NPI:1740301522
Name:HART, MELINDA ELIA (PT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ELIA
Last Name:HART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:BETSY
Other - Last Name:ELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:31 GILBERT ST # 1
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1718
Mailing Address - Country:US
Mailing Address - Phone:617-835-6420
Mailing Address - Fax:
Practice Address - Street 1:57 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2141
Practice Address - Country:US
Practice Address - Phone:978-354-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT 15369OtherLISENCE