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General NPI Number Information
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NPI Number | 1457552820
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Entity Type | Individual
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Provider Name | NANCY LOU MELLOR PHYSICAL THERAPY ASS
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13197 CHURCH ST
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City | PIGEON FALLS
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State | WI
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Zip | 54760
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Country | US
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Telephone | 715-983-2293
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Fax |
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Provider Business Mailing Address
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Address Line | 822 PIERCE ST
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-1525
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Country | US
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Telephone | 715-284-9765
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 589-019
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License Number State | WI
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