Basic Information
| Provider Information | |||||||||
| NPI: | 1912394552 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | COMEAU | ||||||||
| FirstName: | MELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 CARLL RD | ||||||||
| Address2: | |||||||||
| City: | BUXTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040933706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074153515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7716 W MANCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | PLAYA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902938408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108234694 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 07/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTL0014393 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 38675 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT3864 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.