Healthcare Provider Details

I. General information

NPI: 1619872801
Provider Name (Legal Business Name): MELICA GIANNE LEE PHSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 VIRGINIA AVE
CAMPBELL CA
95008-3908
US

IV. Provider business mailing address

238 VIRGINIA AVE
CAMPBELL CA
95008-3908
US

V. Phone/Fax

Practice location:
  • Phone: 408-379-8114
  • Fax: 408-379-0659
Mailing address:
  • Phone: 408-379-8114
  • Fax: 408-379-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: