Provider Demographics
NPI:1073555439
Name:HSIEH, MELISSA JENNIFER (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JENNIFER
Last Name:HSIEH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JENNIFER
Other - Last Name:DELFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2800 E DESERT INN RD
Mailing Address - Street 2:#200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121
Mailing Address - Country:US
Mailing Address - Phone:702-892-9077
Mailing Address - Fax:702-892-9044
Practice Address - Street 1:8402 W CENTENNIAL PARKWAY
Practice Address - Street 2:#240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-386-1250
Practice Address - Fax:702-386-1251
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509260Medicaid
NVCS353ZMedicare PIN