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General NPI Number Information
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NPI Number | 1679641435
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Entity Type | Individual
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Provider Name | BRENT F. MELIUS P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 1700 OLD GATESBURG RD SUITE 210
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City | STATE COLLEGE
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State | PA
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Zip | 16803-2276
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Country | US
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Telephone | 814-278-1912
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Fax | 814-278-1921
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Provider Business Mailing Address
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Address Line | 430 INNOVATION DRIVE
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City | BLAIRSVILLE
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State | PA
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Zip | 15717-8096
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Country | US
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Telephone | 724-343-4060
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Fax | 724-343-4069
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT013516L
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License Number State | PA
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