Provider Demographics
NPI:1114907227
Name:MELLING, BENNETT G (PT, MOMT)
Entity Type:Individual
Prefix:MR
First Name:BENNETT
Middle Name:G
Last Name:MELLING
Suffix:
Gender:M
Credentials:PT, MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 NW PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7627
Mailing Address - Country:US
Mailing Address - Phone:816-858-3250
Mailing Address - Fax:816-858-3253
Practice Address - Street 1:2425 NW PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7627
Practice Address - Country:US
Practice Address - Phone:816-858-3250
Practice Address - Fax:816-858-3253
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0462225100000X
KS11-00945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09945037OtherBLUE CROSS & BLUE SHIELD
MO5093654OtherAETNA