Provider Demographics
NPI:1841414802
Name:MISSY'S MIGHTY MUNCHKINS, LLC
Entity Type:Organization
Organization Name:MISSY'S MIGHTY MUNCHKINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:765-748-2213
Mailing Address - Street 1:6101 N CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5895
Mailing Address - Country:US
Mailing Address - Phone:765-748-2213
Mailing Address - Fax:765-289-7375
Practice Address - Street 1:6101 N CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5895
Practice Address - Country:US
Practice Address - Phone:765-748-2213
Practice Address - Fax:765-289-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005093A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty