MEDICARE: DR. MELANIE RENEE SHORTRIDGE 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	39111	CA

General Provider Information

NPI Number	:	1639424922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE RENEE SHORTRIDGE PT, DPT

Provider Business Mailing Address
First Line	:	4891 RONSON CT STE I
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1815
Country	:	US
Telephone Number	:	858-752-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4891 RONSON CT STE I
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1815
Country	:	US
Telephone Number	:	858-752-0500
Fax Number	:

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

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	02/26/2023

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