Doctor Name: | MS. MELINDA C BROADSTONE |
NPI Number: | 1396076352 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | O.T., M.T., CLT |
License Number: | MA32767 |
Business Practice Address: | 61 Ferry Rd Ne Fort Walton Beach, FL - 325485170 |
Business Phone Number: | 8502173096 |
Business Fax Number: | |
Mailing Address: | Po Box 2472, FORT WALTON BEACH |
State: | FL |
Postal Code: | 325492472 |
Phone Number: | 8502173096 |
Fax Number: | |
NPI Enumeration Date: | 01/14/2010 |
NPI Last Update Date: | 01/14/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA32767 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |