Provider Demographics
NPI:1063804615
Name:THOMPSON, MELISSA NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:NICOLE
Other - Last Name:GROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 HAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4103
Mailing Address - Country:US
Mailing Address - Phone:248-853-7555
Mailing Address - Fax:
Practice Address - Street 1:26212 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0918
Practice Address - Country:US
Practice Address - Phone:248-268-4155
Practice Address - Fax:248-268-4142
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP55360016Medicare UPIN