Provider Demographics
NPI:1811475429
Name:GOLUS, MELISSA (ATC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GOLUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NE
Mailing Address - Zip Code:68421-0154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HOYT ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NE
Practice Address - Zip Code:68421-3073
Practice Address - Country:US
Practice Address - Phone:308-995-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8482255A2300X
NE22372207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services