Melissa Joan Anderson, PT, DPT

Key facts

NPI

1861895641

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

8513 (AZ)

Practice address

520 Rose LN
Physical Therapy Department
Wickenburg, AZ 85390-1447

Phone

(928) 684-5528

NPI assigned

Oct 7, 2014

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 7, 2014.

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412640000000",
    "number": "1861895641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 ROSE LN",
            "address_2": "PHYSICAL THERAPY DEPARTMENT",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853901447",
            "telephone_number": "928-684-5528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 ROSE LN",
            "address_2": "PHYSICAL THERAPY DEPARTMENT",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853901447",
            "telephone_number": "928-684-5528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MELISSA",
        "middle_name": "JOAN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "8513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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