Healthcare Provider Details

I. General information

NPI: 1366620270
Provider Name (Legal Business Name): MELISSA HANDLAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 FLAMEWOOD DR
SAINT LOUIS MO
63129-2526
US

IV. Provider business mailing address

1211 WAGON WHEEL TRL
O FALLON MO
63366-3754
US

V. Phone/Fax

Practice location:
  • Phone: 314-339-7430
  • Fax: 314-449-9173
Mailing address:
  • Phone: 314-779-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2003008012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: