Basic Information
| Provider Information | |||||||||
| NPI: | 1316503766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PADGETT | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANNE | ||||||||
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| OtherLastName: | HAMNER | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2705 N LEBANON ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460528622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654858852 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2485 E WABASH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460419400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654858100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2019 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05008599A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.