Provider Demographics
NPI:1285915546
Name:MELLO, PETER DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:DAVID
Last Name:MELLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BEDFORD ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3180
Mailing Address - Country:US
Mailing Address - Phone:508-807-0146
Mailing Address - Fax:508-807-0134
Practice Address - Street 1:620 BEDFORD ST STE A
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3180
Practice Address - Country:US
Practice Address - Phone:508-807-0146
Practice Address - Fax:508-807-0134
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03515225100000X
GAPT012175225100000X
MA21577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist