Provider Demographics
NPI:1932225851
Name:MELANSON, SARAH MAE (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MAE
Last Name:MELANSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CINEMA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3290
Mailing Address - Country:US
Mailing Address - Phone:978-466-6677
Mailing Address - Fax:978-466-1133
Practice Address - Street 1:33 ELECTRIC AVE
Practice Address - Street 2:STE B10
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7954
Practice Address - Country:US
Practice Address - Phone:978-353-0030
Practice Address - Fax:978-353-1133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8110225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant