Provider Demographics
NPI:1376632398
Name:CHURCH, MELISSA RUTH (PT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:RUTH
Last Name:CHURCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15100 METCALF AVE
Mailing Address - Street 2:SUITE102
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2808
Mailing Address - Country:US
Mailing Address - Phone:913-897-1100
Mailing Address - Fax:913-897-9696
Practice Address - Street 1:15100 METCALF AVE
Practice Address - Street 2:SUITE102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2808
Practice Address - Country:US
Practice Address - Phone:913-897-1100
Practice Address - Fax:913-897-9696
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS11-027152251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic