Healthcare Provider Details

I. General information

NPI: 1578529434
Provider Name (Legal Business Name): MELISSA ANNE CZUBAJ DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MAIN ST
FRANKENMUTH MI
48734-1152
US

IV. Provider business mailing address

5153 LOGANBERRY DR
SAGINAW MI
48603
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-1300
  • Fax: 989-652-1304
Mailing address:
  • Phone: 989-790-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012435
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number060202027
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: