Individual
MRS. MELISSA ANN DALLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2021 S ALVERNO RD, MANITOWOC, WI 54220-9208
(920) 683-4592
Mailing address
1123 LEIST RD, REEDSVILLE, WI 54230-9552
(920) 242-2932
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
537-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40380400
—
WI
Enumeration date
11/06/2006
Last updated
03/06/2013
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