Provider Demographics
NPI:1093872277
Name:MAGNUSSEN, MELISSA A (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MAGNUSSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:97 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1606
Mailing Address - Country:US
Mailing Address - Phone:508-528-6100
Mailing Address - Fax:
Practice Address - Street 1:620 OLD WEST CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2912
Practice Address - Country:US
Practice Address - Phone:508-528-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist