Provider Demographics
NPI:1629755624
Name:MELVIN, ANDREW PHILLIP (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILLIP
Last Name:MELVIN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 COLLEEN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2309
Mailing Address - Country:US
Mailing Address - Phone:316-779-7961
Mailing Address - Fax:
Practice Address - Street 1:608 COLLEEN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2309
Practice Address - Country:US
Practice Address - Phone:316-779-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-007102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer