Healthcare Provider Details

I. General information

NPI: 1033501721
Provider Name (Legal Business Name): MELISSA HEINRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 E 6TH ST
ALLIANCE NE
69301-3600
US

IV. Provider business mailing address

815 BOX BUTTE AVE
ALLIANCE NE
69301-2939
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-5675
  • Fax:
Mailing address:
  • Phone: 308-760-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number840
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: