Healthcare Provider Details

I. General information

NPI: 1992241368
Provider Name (Legal Business Name): BRANDON MELESTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROS CIR
REPUBLIC WA
99166-5002
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 509-779-0831
  • Fax:
Mailing address:
  • Phone: 423-682-8840
  • Fax: 423-602-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1265906
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051828T
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0015207
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: