Provider Demographics
NPI:1154662088
Name:KLEIN, MELISSA DANIELLE (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DANIELLE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DANIELLE
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:208 CONCOURSE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8210
Mailing Address - Country:US
Mailing Address - Phone:707-303-4992
Mailing Address - Fax:707-303-4996
Practice Address - Street 1:208 CONCOURSE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:707-303-4992
Practice Address - Fax:707-303-4996
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 39989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist