Provider Demographics
NPI:1457557993
Name:KRZYSZTOF, MELISA
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:KRZYSZTOF
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 1:100 PENZANCE AVE APT 79
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8259
Mailing Address - Country:US
Mailing Address - Phone:413-443-0073
Mailing Address - Fax:
Practice Address - Street 1:700 COLORADO BLVD # 318
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4084
Practice Address - Country:US
Practice Address - Phone:303-339-7408
Practice Address - Fax:866-293-4719
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7544225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant