MEDICARE: MELISSA ETTEN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	03948	IA

General Provider Information

NPI Number	:	1194735043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ETTEN DPT

Provider Business Mailing Address
First Line	:	PO BOX 1475
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50305-1475
Country	:	US
Telephone Number	:	515-222-7350
Fax Number	:	515-222-7355

Provider Business Practice Location Address
First Line	:	1601 NW 114TH ST STE 155
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-7046
Country	:	US
Telephone Number	:	515-222-7350
Fax Number	:	515-222-7355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	03/17/2018

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Directions to “ MELISSA ETTEN DPT” Practice Location

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