Provider Demographics
NPI:1154755858
Name:LUETY, MELISSA LAUREN PHEE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LAUREN PHEE
Last Name:LUETY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3196
Mailing Address - Country:US
Mailing Address - Phone:312-243-9350
Mailing Address - Fax:
Practice Address - Street 1:225 S SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3196
Practice Address - Country:US
Practice Address - Phone:312-243-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.020196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist