Provider Demographics
NPI:1730844952
Name:KELTNER, MELISSA (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KELTNER
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 1:7310 N 16TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5259
Mailing Address - Country:US
Mailing Address - Phone:602-535-8255
Mailing Address - Fax:602-535-8254
Practice Address - Street 1:7310 N 16TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5259
Practice Address - Country:US
Practice Address - Phone:602-535-8255
Practice Address - Fax:602-535-8254
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist