Provider Demographics
NPI:1053892083
Name:WINDER, MELISSA ANNE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:WINDER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7107 S 161ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1086
Mailing Address - Country:US
Mailing Address - Phone:913-544-8159
Mailing Address - Fax:
Practice Address - Street 1:8031 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3158
Practice Address - Country:US
Practice Address - Phone:402-391-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3305261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy