MEDICARE: MELISSA GILBERT BROWN P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	0000003603	TN

General Provider Information

NPI Number	:	1225244932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GILBERT BROWN P.T.A.

Provider Business Mailing Address
First Line	:	2149 N MARBLE TOP RD
Second Line	:
City	:	CHICKAMAUGA
State	:	GA
Zip	:	30707-2037
Country	:	US
Telephone Number	:	706-375-6482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 RIVERSIDE DR
Second Line	:	STE 270
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-4309
Country	:	US
Telephone Number	:	423-778-3196
Fax Number	:	423-778-6197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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