Provider Demographics
NPI:1306172515
Name:OLESON, MELISSA A (DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:OLESON
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 1:33 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1408
Mailing Address - Country:US
Mailing Address - Phone:603-643-7788
Mailing Address - Fax:603-643-0022
Practice Address - Street 1:33 MORGAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1408
Practice Address - Country:US
Practice Address - Phone:603-643-7788
Practice Address - Fax:603-643-0022
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016940Medicaid
NH30397724Medicaid
VT1016940Medicaid