Provider Demographics
NPI:1700343803
Name:DAUGHTY, MELISSA DENISE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DENISE
Last Name:DAUGHTY
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 1:714 BALLINGER ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5918
Mailing Address - Country:US
Mailing Address - Phone:620-275-0291
Mailing Address - Fax:620-272-0364
Practice Address - Street 1:714 BALLINGER ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5918
Practice Address - Country:US
Practice Address - Phone:620-275-0291
Practice Address - Fax:620-272-0364
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist