Healthcare Provider Details

I. General information

NPI: 1760694293
Provider Name (Legal Business Name): MELISSA ANNE HUBAND PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST BLDG 285
FORT JOHNSON LA
71459-5102
US

IV. Provider business mailing address

1204 SW WESTMINISTER RD
BLUE SPRINGS MO
64014-3556
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3517
  • Fax:
Mailing address:
  • Phone: 816-224-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2006003821
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: