Healthcare Provider Details

I. General information

NPI: 1518092337
Provider Name (Legal Business Name): MELISSA GREALIS DPT,MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WELLNESS DR
WILLISTON VT
05495-2088
US

IV. Provider business mailing address

236 MARTINDALE RD
SHELBURNE VT
05482-6721
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-1358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number007986
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400003713
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: