Provider Demographics
NPI:1427545359
Name:MOLCHAN, MELISSA KAY (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:MOLCHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8975 MARABELLA CT NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7439
Mailing Address - Country:US
Mailing Address - Phone:717-715-3405
Mailing Address - Fax:
Practice Address - Street 1:8975 MARABELLA CT NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7439
Practice Address - Country:US
Practice Address - Phone:717-715-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002301225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant