Provider Demographics
NPI:1689183055
Name:WHITE, MELANIE DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DAWN
Last Name:WHITE
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 1:5000 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-4510
Mailing Address - Country:US
Mailing Address - Phone:785-271-8100
Mailing Address - Fax:
Practice Address - Street 1:5000 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4510
Practice Address - Country:US
Practice Address - Phone:785-271-8100
Practice Address - Fax:785-271-9257
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02697225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant