Provider Demographics
NPI:1356954846
Name:KNUTH, MELISSA LEEANN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEEANN
Last Name:KNUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32100 COUNTY HWY S
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:WI
Mailing Address - Zip Code:53924-6908
Mailing Address - Country:US
Mailing Address - Phone:608-604-4438
Mailing Address - Fax:
Practice Address - Street 1:1400 W SEMINARY ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2036
Practice Address - Country:US
Practice Address - Phone:608-647-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2468-19208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty