Provider Demographics
NPI:1558662619
Name:THOMPSON, MELISSA ANN (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:KUZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:500 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-6036
Mailing Address - Country:US
Mailing Address - Phone:814-762-8356
Mailing Address - Fax:814-762-8366
Practice Address - Street 1:500 PLAZA DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-6036
Practice Address - Country:US
Practice Address - Phone:814-762-8356
Practice Address - Fax:814-762-8366
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA800777R9XMedicare Oscar/Certification