Provider Demographics
NPI:1063770493
Name:BROWN, MELODY ANN (MS PT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:ANN
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:125 RIVERSTONE TER
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5218
Practice Address - Country:US
Practice Address - Phone:770-479-0472
Practice Address - Fax:770-479-0472
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist