Provider Demographics
NPI:1811246226
Name:HALL, MELISSA JANE (LMT, HHP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MAIN ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7128
Mailing Address - Country:US
Mailing Address - Phone:802-579-9644
Mailing Address - Fax:
Practice Address - Street 1:167 MAIN ST
Practice Address - Street 2:SUITE 410
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7128
Practice Address - Country:US
Practice Address - Phone:802-579-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist