Provider Demographics
NPI:1578850939
Name:KAPPELMAN, MELISSA A (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:KAPPELMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7804
Mailing Address - Country:US
Mailing Address - Phone:623-935-5505
Mailing Address - Fax:
Practice Address - Street 1:8811 N 51ST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4949
Practice Address - Country:US
Practice Address - Phone:623-915-2726
Practice Address - Fax:623-915-2728
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7776A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant