Active NPI
Melissa Lynn Bourgeois, DPT
- Physical Therapist
- Windsor, CT
National Provider Identifier
1790295772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11013
- Practice address
- 1 Emerson Dr
Windsor, CT 06095-3204 - Phone
- (860) 688-6443
- NPI assigned
- Oct 4, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4154 | NH | |
| Physical Therapist | 225100000X | 11013 | CT | Primary |
Addresses
Primary practice location
1 Emerson Dr
Windsor, CT 06095-3204
Mailing address
8 Thompson Ave
Hooksett, NH 03106
Other practice location 1
25 Ridgewood Rd
Bedford, NH 03110-6510
Phone (603) 623-8805
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11013 | CT | MD | Physical Therapist |
| 4154 | NH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1790295772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 THOMPSON AVE",
"city": "HOOKSETT",
"state": "NH",
"postal_code": "03106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 EMERSON DR",
"city": "WINDSOR",
"state": "CT",
"postal_code": "060953204",
"telephone_number": "860-688-6443"
}
],
"practiceLocations": [
{
"address_1": "25 Ridgewood Rd",
"address_purpose": "LOCATION",
"city": "Bedford",
"state": "NH",
"postal_code": "031106510",
"country_code": "US",
"telephone_number": "603-623-8805",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOURGEOIS",
"first_name": "MELISSA",
"middle_name": "LYNN",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-04",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NH",
"license": "4154",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "11013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.