Healthcare Provider Details

I. General information

NPI: 1982524583
Provider Name (Legal Business Name): MELISSA ANN STILLWAGON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ANN MILLER PT, DPT

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 MEADOW VIEW DR
BUELLTON CA
93427-9319
US

IV. Provider business mailing address

531 MEADOW VIEW DR
BUELLTON CA
93427-9319
US

V. Phone/Fax

Practice location:
  • Phone: 805-610-8452
  • Fax:
Mailing address:
  • Phone: 805-610-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT293392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: