Organization
MELLEVORE, LLC
Active
Other names
Mathis Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY MATHIS OTD, CHT (OWNER)
(785) 320-6616
Entity
Organization
Contact information
Practice address
935 E 4TH ST, JUNCITON CITY, KS 66441
(785) 579-6790
(785) 579-6792
Mailing address
1228 WESTLOOP PL, #159, MANHATTAN, KS 66502-2840
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1103031
KS
225X00000X
Occupational Therapist
1700445
KS
235Z00000X
Speech-Language Pathologist
3339
KS
Other
Enumeration date
02/14/2017
Last updated
01/23/2020
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