Provider Demographics
NPI:1801252317
Name:HINES, MELISSA MAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAE
Last Name:HINES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 YARMOUTH ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5882
Mailing Address - Country:US
Mailing Address - Phone:978-578-4730
Mailing Address - Fax:
Practice Address - Street 1:364 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3806
Practice Address - Country:US
Practice Address - Phone:617-236-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic