Healthcare Provider Details

I. General information

NPI: 1003097932
Provider Name (Legal Business Name): MELISSA MARQUIS MARTEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PLEASANT ST
CONCORD NH
03301-7504
US

IV. Provider business mailing address

239 PLEASANT ST
CONCORD NH
03301-7504
US

V. Phone/Fax

Practice location:
  • Phone: 603-410-3419
  • Fax:
Mailing address:
  • Phone: 603-410-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0904
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: