Provider Demographics
NPI:1881456200
Name:EWING, MELISSA (MS,ATC,LAT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:MS,ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-3200
Mailing Address - Country:US
Mailing Address - Phone:402-363-5734
Mailing Address - Fax:
Practice Address - Street 1:1125 E 8TH ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-3200
Practice Address - Country:US
Practice Address - Phone:402-363-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer