Provider Demographics
NPI:1043249410
Name:STILL, MELISSA (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:STILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3291 S THOMPSON ST
Mailing Address - Street 2:SUITE C103
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7043
Mailing Address - Country:US
Mailing Address - Phone:479-750-3535
Mailing Address - Fax:479-750-3539
Practice Address - Street 1:3291 S THOMPSON ST
Practice Address - Street 2:SUITE C103
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7043
Practice Address - Country:US
Practice Address - Phone:479-750-3535
Practice Address - Fax:479-750-3539
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist