Active NPI
Melissa L McMullen, PT, DPT
- Physical Therapist
- Fairbanks, AK
National Provider Identifier
1801101753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2175
- Practice address
- 398 Hamilton Ave
Fairbanks, AK 99701-3537 - Phone
- (907) 374-4911
- NPI assigned
- Aug 16, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2175 | AK | Primary |
| Physical Therapist | 225100000X | 1194093 | TX |
Addresses
Primary practice location
398 Hamilton Ave
Fairbanks, AK 99701-3537
Mailing address
398 Hamilton Ave
Fairbanks, AK 99701-3537
Phone (907) 374-4911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2175 | AK | MD | Physical Therapist |
| 1194093 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281916800000",
"number": "1801101753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "398 HAMILTON AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997013537",
"telephone_number": "907-374-4911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "398 HAMILTON AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997013537",
"telephone_number": "907-374-4911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMULLEN",
"first_name": "MELISSA",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-16",
"last_updated": "2010-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AK",
"license": "2175",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1194093",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.