Healthcare Provider Details

I. General information

NPI: 1790842300
Provider Name (Legal Business Name): MELISSA MARIE BROOKS PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA HAWKER PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 BROAD AVENUE
BELLE VERNON PA
15012
US

IV. Provider business mailing address

625 LINCOLN AVE SUITE 107
NORTH CHARLEROI PA
15022
US

V. Phone/Fax

Practice location:
  • Phone: 727-929-5774
  • Fax: 724-929-9524
Mailing address:
  • Phone: 724-483-3610
  • Fax: 724-489-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016610
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT001735
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: