Provider Demographics
NPI:1992754188
Name:MEISTE, MELISSA M (MSPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MEISTE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12723 N BELLWOOD DR
Mailing Address - Street 2:STE 10
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7275
Mailing Address - Country:US
Mailing Address - Phone:616-796-9391
Mailing Address - Fax:888-714-4474
Practice Address - Street 1:12723 N BELLWOOD DR
Practice Address - Street 2:STE 10
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7275
Practice Address - Country:US
Practice Address - Phone:616-796-9391
Practice Address - Fax:888-714-4474
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501010233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4562Medicare PIN