Provider Demographics
NPI:1124430426
Name:SCHROETER, MELANIE D (DPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:SCHROETER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 BROADWAY AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3633
Mailing Address - Country:US
Mailing Address - Phone:620-786-6515
Mailing Address - Fax:620-792-6602
Practice Address - Street 1:400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2300
Practice Address - Country:US
Practice Address - Phone:620-241-4201
Practice Address - Fax:620-241-4210
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist