Individual
MELISSA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
301 S LAFAYETTE ST, SOUTH LYON, MI 48178-1407
(248) 486-1110
Mailing address
303 ROE ST, #18, PLYMOUTH, MI 48170-6264
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601000053
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
—
Enumeration date
11/01/2011
Last updated
11/01/2011
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