Provider Demographics
NPI:1629448550
Name:HEWITT, MELISSA CHRISTINE (PTA, NMT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CHRISTINE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:PTA, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1982 SUSAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1557
Mailing Address - Country:US
Mailing Address - Phone:920-410-7837
Mailing Address - Fax:
Practice Address - Street 1:1119 HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956
Practice Address - Country:US
Practice Address - Phone:920-410-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2350-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant