Provider Demographics
NPI:1790356046
Name:PINGEL, MELISSA G (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:PINGEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:G
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:3951 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1088
Mailing Address - Country:US
Mailing Address - Phone:269-329-0200
Mailing Address - Fax:
Practice Address - Street 1:7566 COBBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3800
Practice Address - Country:US
Practice Address - Phone:269-303-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003444225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant