Provider Demographics
NPI:1992811798
Name:THESS, MELISSA J (PT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:THESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:J
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:555 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6825
Mailing Address - Country:US
Mailing Address - Phone:314-432-7100
Mailing Address - Fax:314-432-7259
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-432-7100
Practice Address - Fax:314-432-7259
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist