Provider Demographics
NPI:1861154056
Name:HARGREAVES, MELISSA (PTA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HARGREAVES
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 1:50 RICHELIEU ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4977
Mailing Address - Country:US
Mailing Address - Phone:401-359-0745
Mailing Address - Fax:
Practice Address - Street 1:11 HUNTOON MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:ROCHDALE
Practice Address - State:MA
Practice Address - Zip Code:01542
Practice Address - Country:US
Practice Address - Phone:508-892-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9706225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant