Provider Demographics
NPI:1033349204
Name:MELHOUSE, LYNN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:MELHOUSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41761 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENYON
Mailing Address - State:MN
Mailing Address - Zip Code:55946-3403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 FOREST AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1643
Practice Address - Country:US
Practice Address - Phone:507-664-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA954225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant