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General NPI Number Information
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NPI Number | 1124156708
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Entity Type | Individual
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Provider Name | MELISSA KOLSBY BEARDSLEY ATC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 SAINT THERESA AVE
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City | WEST ROXBURY
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State | MA
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Zip | 02132-3419
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Country | US
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Telephone | 617-325-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 95 ANDREWS ST
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City | MEDFORD
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State | MA
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Zip | 02155-1226
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Country | US
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Telephone | 781-391-0381
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AH 1079-AT
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License Number State | MA
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