Healthcare Provider Details

I. General information

NPI: 1437102308
Provider Name (Legal Business Name): MELANIE LYNN WRENCH MPT OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 VISTA WAY SUITE 111
OCEANSIDE CA
92054-6372
US

IV. Provider business mailing address

2741 VISTA WAY SUITE 111
OCEANSIDE CA
92054-6372
US

V. Phone/Fax

Practice location:
  • Phone: 760-757-0222
  • Fax: 760-757-0224
Mailing address:
  • Phone: 760-757-0222
  • Fax: 760-757-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6865
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: