Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11-02715 | KS |
N | 2251S0007X | Physical Therapist - Sports | 11-02715 | KS |
N | 2251X0800X | Physical Therapist - Orthopedic | 11-02715 | KS |
NPI | 1376632398 |
---|---|
Provider Name | Ms. Melissa Ruth Church |
First Address | Overland Park, KS 66223-2808 |
Second Address | Overland Park, KS 66223-2808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 25/11/2020 |