Provider Demographics
NPI:1093808099
Name:MELBY, KARI J (PT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:J
Last Name:MELBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:J
Other - Last Name:MELBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1655 N GRANDVIEW LN STE 204
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0877
Mailing Address - Country:US
Mailing Address - Phone:170-175-1202
Mailing Address - Fax:
Practice Address - Street 1:1655 N GRANDVIEW LN STE 204
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0877
Practice Address - Country:US
Practice Address - Phone:170-175-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013264225100000X
ND2265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931550OtherMEDICARE RAILROAD
IL202845117Medicare PIN
ILP00931550OtherMEDICARE RAILROAD
ILK33685Medicare PIN