Provider Demographics
NPI:1740880152
Name:BRANDON, MELISSA ANNE (DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:BRANDON
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:711 LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-5500
Mailing Address - Country:US
Mailing Address - Phone:978-219-4645
Mailing Address - Fax:
Practice Address - Street 1:290 BAKER AVE STE N101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2193
Practice Address - Country:US
Practice Address - Phone:978-219-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist