Provider Demographics
NPI:1124639182
Name:SANCHEZ, MELYNDA JADE
Entity type:Individual
Prefix:
First Name:MELYNDA
Middle Name:JADE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1329
Mailing Address - Country:US
Mailing Address - Phone:316-796-4314
Mailing Address - Fax:
Practice Address - Street 1:720 W CENTRAL AVE STE 206
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2112
Practice Address - Country:US
Practice Address - Phone:316-796-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist