Provider Demographics
NPI:1073728549
Name:MOOS, MELISSA (PHYSICAL THRAPIST)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:MOOS
Suffix:
Gender:F
Credentials:PHYSICAL THRAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W 94TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-1975
Mailing Address - Country:US
Mailing Address - Phone:402-744-2000
Mailing Address - Fax:
Practice Address - Street 1:240 W 94TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-1975
Practice Address - Country:US
Practice Address - Phone:402-744-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2619225100000X
TX1169202225100000X
NE2519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025372500Medicaid