Provider Demographics
NPI:1598026411
Name:THURSTON, MELISSA ANN (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:THURSTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 CORTE VERA CRUZ
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5792
Mailing Address - Country:US
Mailing Address - Phone:801-885-1170
Mailing Address - Fax:
Practice Address - Street 1:2706 CORTE VERA CRUZ
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5792
Practice Address - Country:US
Practice Address - Phone:801-885-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist