Provider Demographics
NPI:1770804601
Name:SWEENEY, MELANIE L (PTA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ENTERPRISE DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-883-8133
Mailing Address - Fax:207-883-8226
Practice Address - Street 1:400 ENTERPRISE DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-8133
Practice Address - Fax:207-883-8226
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3501225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant