Provider Demographics
NPI:1386866002
Name:AVITIA, MELISSA RENEE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:AVITIA
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 1:951 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1112
Mailing Address - Country:US
Mailing Address - Phone:636-462-6098
Mailing Address - Fax:
Practice Address - Street 1:951 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1112
Practice Address - Country:US
Practice Address - Phone:636-462-6098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009036117225200000X
KS14-02054225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant