Provider Demographics
NPI:1073843371
Name:KAMINSKI, MELISSA MARIE (PT DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:DIORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31237 SIERRA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8221
Mailing Address - Country:US
Mailing Address - Phone:760-855-4498
Mailing Address - Fax:
Practice Address - Street 1:30141 ANTELOPE RD STE A
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8066
Practice Address - Country:US
Practice Address - Phone:951-723-8100
Practice Address - Fax:951-723-8101
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB221065Medicare PIN
CACA143657Medicare PIN
CACA131712Medicare PIN