Individual
MISS MELISSA GRACE KEROACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-0111
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-0111
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
PT4566
ME
225100000X
Physical Therapist
Primary
PT4566
ME
Other
Enumeration date
02/26/2019
Last updated
02/26/2019
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