Provider Demographics
NPI:1699809814
Name:HANSEN, MELISSA LEE (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:HANSEN
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 1:604 LIBERTY ST STE 227
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1776
Mailing Address - Country:US
Mailing Address - Phone:641-621-0230
Mailing Address - Fax:641-621-0319
Practice Address - Street 1:604 LIBERTY ST STE 227
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1776
Practice Address - Country:US
Practice Address - Phone:641-621-0230
Practice Address - Fax:641-621-0319
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist