Provider Demographics
NPI:1346433844
Name:SUNDBERG, MELISSA ANN (PT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1917 ABBOTT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3448
Mailing Address - Country:US
Mailing Address - Phone:907-279-4266
Mailing Address - Fax:907-743-8283
Practice Address - Street 1:5660 B ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1641
Practice Address - Country:US
Practice Address - Phone:907-215-3045
Practice Address - Fax:907-802-4538
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13402251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic