Provider Demographics
NPI:1104092147
Name:TURNER, MELISSA JOAN (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOAN
Last Name:TURNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22103 S WALNUT BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-9399
Mailing Address - Country:US
Mailing Address - Phone:970-209-3188
Mailing Address - Fax:
Practice Address - Street 1:22103 S WALNUT BLUFF RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-9399
Practice Address - Country:US
Practice Address - Phone:970-209-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36482251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics