Provider Demographics
NPI:1326001702
Name:CRUICE, MELISSA ANN (ATC, CSCS)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ANN
Last Name:CRUICE
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SCOTTDALE RD
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2328
Mailing Address - Country:US
Mailing Address - Phone:610-626-5752
Mailing Address - Fax:
Practice Address - Street 1:370 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1336
Practice Address - Country:US
Practice Address - Phone:610-896-1124
Practice Address - Fax:610-795-7963
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer