Provider Demographics
NPI:1326828047
Name:HORSTMANN, MELISSA ELLEN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELLEN
Last Name:HORSTMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 10TH STREET PL
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1331
Mailing Address - Country:US
Mailing Address - Phone:319-471-2719
Mailing Address - Fax:
Practice Address - Street 1:555 W CHERRY ST STE 5
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9800
Practice Address - Country:US
Practice Address - Phone:319-471-2719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist