Provider Demographics
NPI:1720238553
Name:MANN, MELLONY JUNE (DPT)
Entity Type:Individual
Prefix:
First Name:MELLONY
Middle Name:JUNE
Last Name:MANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELLONY
Other - Middle Name:JUNE
Other - Last Name:MEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3380
Mailing Address - Fax:816-346-1372
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-234-3380
Practice Address - Fax:816-346-1372
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04815225100000X
MO2008028214225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant