Provider Demographics
NPI:1194866079
Name:KOLECKE, MELISSA (MPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KOLECKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:828 BUSSE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-384-6804
Mailing Address - Fax:847-384-6806
Practice Address - Street 1:500 N KINGSBURY ST
Practice Address - Street 2:EAST BANK CLUB
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4021
Practice Address - Country:US
Practice Address - Phone:312-527-5801
Practice Address - Fax:312-644-4567
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist