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General NPI Number Information
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NPI Number | 1356954846
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Entity Type | Individual
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Provider Name | MELISSA LEEANN KNUTH
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Gender | Female
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 1400 W SEMINARY ST
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City | RICHLAND CENTER
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State | WI
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Zip | 53581-2036
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Country | US
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Telephone | 608-647-8931
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Fax |
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Provider Business Mailing Address
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Address Line | 32100 COUNTY HWY S
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City | CAZENOVIA
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State | WI
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Zip | 53924-6908
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Country | US
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Telephone | 608-604-4438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2468-19
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License Number State | WI
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