Provider Demographics
NPI:1972655454
Name:WARDERS, MELISSA DAWN (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:WARDERS
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 1:10009 PRAIRIE WOODS CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3909
Mailing Address - Country:US
Mailing Address - Phone:316-721-3595
Mailing Address - Fax:
Practice Address - Street 1:3725 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4403
Practice Address - Country:US
Practice Address - Phone:316-219-9646
Practice Address - Fax:316-219-9649
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-032632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic