Healthcare Provider Details

I. General information

NPI: 1790377638
Provider Name (Legal Business Name): MELINDA TO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39141 CIVIC CENTER DR STE 120
FREMONT CA
94538-5831
US

IV. Provider business mailing address

2679 GLEN HARDY CT
SAN JOSE CA
95148-4122
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-9672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: