Provider Demographics
NPI:1538317060
Name:STEBBINS, MELISSA G (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:STEBBINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:GERSHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 5300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:978-263-0007
Mailing Address - Fax:978-263-0014
Practice Address - Street 1:1335 W. MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331
Practice Address - Country:US
Practice Address - Phone:616-888-3184
Practice Address - Fax:978-263-0014
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302182225100000X
MA18354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110121518AMedicaid
MA4788150001Medicare NSC