Provider Demographics
NPI:1528523594
Name:RABIDEAU, MELISSA (PT)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:RABIDEAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:418 N MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1813
Mailing Address - Country:US
Mailing Address - Phone:844-313-2246
Mailing Address - Fax:517-798-5705
Practice Address - Street 1:418 N MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1813
Practice Address - Country:US
Practice Address - Phone:844-313-2246
Practice Address - Fax:517-798-5705
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 225200000X, 225X00000X, 235Z00000X, 235Z00000X
MI7501011843225700000X
MI5501017204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF271510OtherBLUE CROSS BLUE SHIELD