Provider Demographics
NPI:1316934748
Name:HEWITT, MELANIE G (PT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:G
Last Name:HEWITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-4907
Mailing Address - Country:US
Mailing Address - Phone:515-241-5785
Mailing Address - Fax:515-241-4415
Practice Address - Street 1:5950 UNIVERSITY AVE
Practice Address - Street 2:STE 285
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8216
Practice Address - Country:US
Practice Address - Phone:515-875-9706
Practice Address - Fax:515-875-9707
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI13050Medicare ID - Type Unspecified