Provider Demographics
NPI:1073626180
Name:ANDERSON, MELISSA SUE (PT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10785 W TWAIN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3026
Mailing Address - Country:US
Mailing Address - Phone:725-726-7847
Mailing Address - Fax:725-726-7876
Practice Address - Street 1:870 SEVEN HILLS DR STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4379
Practice Address - Country:US
Practice Address - Phone:725-726-7847
Practice Address - Fax:725-726-7876
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV2044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509577Medicaid
NV36510Medicare UPIN