Provider Demographics
NPI:1790842300
Name:BROOKS, MELISSA MARIE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HAWKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:625 LINCOLN AVE SUITE 107
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-3610
Mailing Address - Fax:724-489-4758
Practice Address - Street 1:812 BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012
Practice Address - Country:US
Practice Address - Phone:727-929-5774
Practice Address - Fax:724-929-9524
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016610225100000X
PADAPT001735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022400270001Medicaid
PA1022400270001Medicaid