Provider Demographics
NPI:1508352352
Name:HARDEN, MELISSA KAY (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:HARDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 W M 21 STE 102
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8164
Mailing Address - Country:US
Mailing Address - Phone:989-725-2299
Mailing Address - Fax:989-723-5614
Practice Address - Street 1:1975 W M 21 STE 102
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-8164
Practice Address - Country:US
Practice Address - Phone:989-725-2299
Practice Address - Fax:989-723-5614
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist