Healthcare Provider Details

I. General information

NPI: 1629909643
Provider Name (Legal Business Name): MELISSA VANDERMEULEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W SUPERIOR ST
WAYLAND MI
49348-1226
US

IV. Provider business mailing address

284 124TH AVE
SHELBYVILLE MI
49344-9715
US

V. Phone/Fax

Practice location:
  • Phone: 269-569-5429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: