Provider Demographics
NPI:1841490091
Name:BELL, MELISIA ANN (DPT)
Entity type:Individual
Prefix:
First Name:MELISIA
Middle Name:ANN
Last Name:BELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISIA
Other - Middle Name:ANN
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 412066
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:439 CHANNEL RD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-6101
Practice Address - Country:US
Practice Address - Phone:803-746-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12164225100000X, 225100000X
TN8548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist