Provider Demographics
NPI:1083706451
Name:MCKNIGHT, MELISSA A (MPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:12842 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2633
Mailing Address - Country:US
Mailing Address - Phone:541-844-4381
Mailing Address - Fax:
Practice Address - Street 1:6080 CENTER DR FL 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-9205
Practice Address - Country:US
Practice Address - Phone:888-859-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5519225100000X
CAPT 27654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241565Medicaid
CAPENDINGOtherPALMETTO GBA
CAPENDINGOtherPALMETTO GBA