Provider Demographics
NPI:1427722719
Name:CUSHMAN, MELISSA ANN (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:24 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5712
Mailing Address - Country:US
Mailing Address - Phone:603-486-7753
Mailing Address - Fax:
Practice Address - Street 1:24 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5712
Practice Address - Country:US
Practice Address - Phone:603-486-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3679225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty