Provider Demographics
NPI:1689651572
Name:WILLIAMS, MELISSA D (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:WILLIAMS
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 1:3314 S KESSLER AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-1133
Mailing Address - Country:US
Mailing Address - Phone:316-409-8828
Mailing Address - Fax:
Practice Address - Street 1:7011 W CENTRAL AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3386
Practice Address - Country:US
Practice Address - Phone:316-946-9662
Practice Address - Fax:316-946-9745
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist