Provider Demographics
NPI:1255652418
Name:SCHUSSMAN, MELISSA (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:SCHUSSMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W UNIVERSITY AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7115
Mailing Address - Country:US
Mailing Address - Phone:928-556-9935
Mailing Address - Fax:
Practice Address - Street 1:906 W UNIVERSITY AVE STE 120
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7115
Practice Address - Country:US
Practice Address - Phone:928-556-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IN05010813A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000781232OtherANTHEM PROVIDER NUMBER
IN201082430Medicaid
IN815500002Medicare PIN
INP01158958Medicare PIN