Healthcare Provider Details

I. General information

NPI: 1346204484
Provider Name (Legal Business Name): MELISSA K JAMES MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 VISTA DR
LARAMIE WY
82070-5530
US

IV. Provider business mailing address

1909 VISTA DR
LARAMIE WY
82070-5599
US

V. Phone/Fax

Practice location:
  • Phone: 307-721-8024
  • Fax: 307-742-3093
Mailing address:
  • Phone: 307-721-8024
  • Fax: 307-358-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-871
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: