Provider Demographics
NPI:1063622272
Name:KUBIC, MELISSA BRANYAN (PT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BRANYAN
Last Name:KUBIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:BRANYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:584 TIKTIN DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-5117
Mailing Address - Country:US
Mailing Address - Phone:423-876-9955
Mailing Address - Fax:423-876-9955
Practice Address - Street 1:1755 GUNBARREL RD
Practice Address - Street 2:206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7137
Practice Address - Country:US
Practice Address - Phone:423-778-8660
Practice Address - Fax:423-778-8655
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist