Provider Demographics
NPI:1306159595
Name:BRICKSON, MELISSA (DPT)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:BRICKSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OKATIE CENTER BLVD S
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7529
Mailing Address - Country:US
Mailing Address - Phone:843-705-9480
Mailing Address - Fax:
Practice Address - Street 1:4 OKATIE CENTER BLVD S STE 101
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7530
Practice Address - Country:US
Practice Address - Phone:843-705-9480
Practice Address - Fax:843-705-9481
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH2838Medicaid