Healthcare Provider Details

I. General information

NPI: 1548303324
Provider Name (Legal Business Name): BRIAN T. MELLO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E MAIN ST
NORTON MA
02766-2571
US

IV. Provider business mailing address

69 BAYVIEW AVE
BERKLEY MA
02779-1924
US

V. Phone/Fax

Practice location:
  • Phone: 508-285-1970
  • Fax: 508-285-1972
Mailing address:
  • Phone: 508-967-7938
  • Fax: 617-488-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16010
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: