Provider Demographics
NPI:1952127409
Name:KOESTER-COMBS, MELINDA (RPT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:KOESTER-COMBS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8124
Mailing Address - Country:US
Mailing Address - Phone:913-206-7898
Mailing Address - Fax:
Practice Address - Street 1:2622 LOCUST RD
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8124
Practice Address - Country:US
Practice Address - Phone:913-206-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107561225100000X
KS11-01996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist