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NPI Code Detail

MEDICARE: BRIAN J MELANCON PT

MEDICARE:   BRIAN J MELANCON  PT
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
1225100000XPhysical Therapist1173320TX

General Provider Information

NPI Number : 1730388513
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN J MELANCON PT
Provider Business Mailing Address
First Line : 18001 HIGHWAY 105 W STE 106
Second Line :
City : MONTGOMERY
State : TX
Zip : 77356-2881
Country : US
Telephone Number : 936-582-2464
Fax Number : 936-582-4697
Provider Business Practice Location Address
First Line : 18001 HIGHWAY 105 W STE 106
Second Line :
City : MONTGOMERY
State : TX
Zip : 77356-2881
Country : US
Telephone Number : 936-582-2464
Fax Number : 936-582-4697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2007
Last Update Date : 04/09/2026

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Directions to “ BRIAN J MELANCON PT” Practice Location

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