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General NPI Number Information
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NPI Number | 1790295772
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Entity Type | Individual
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Provider Name | MELISSA LYNN BOURGEOIS DPT
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Gender | Female
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1 EMERSON DR
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City | WINDSOR
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State | CT
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Zip | 06095-3204
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Country | US
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Telephone | 860-688-6443
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Fax |
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Provider Business Mailing Address
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Address Line | 8 THOMPSON AVE
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City | HOOKSETT
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State | NH
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Zip | 03106
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4154
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11013
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License Number State | CT
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