Provider Demographics
NPI:1366620270
Name:HANDLAN, MELISSA (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HANDLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 WAGON WHEEL TRL
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3754
Mailing Address - Country:US
Mailing Address - Phone:314-779-3004
Mailing Address - Fax:
Practice Address - Street 1:2806 FLAMEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-2526
Practice Address - Country:US
Practice Address - Phone:314-339-7430
Practice Address - Fax:314-449-9173
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003008012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist