MEDICARE: MELISSA L AP PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	293521	CA

General Provider Information

NPI Number	:	1083122691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA L AP PT, DPT

Provider Business Mailing Address
First Line	:	24630 WASHINGTON AVE STE 200
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-6177
Country	:	US
Telephone Number	:	951-696-9353
Fax Number	:	951-973-7216

Provider Business Practice Location Address
First Line	:	6850 BROCKTON AVE STE 212
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3815
Country	:	US
Telephone Number	:	951-534-0600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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