Provider Demographics
NPI:1285683128
Name:SEQUEIRA, MELISSA M (PT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:M
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:102 CATHERINE LN STE A
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5701
Mailing Address - Country:US
Mailing Address - Phone:530-478-1933
Mailing Address - Fax:530-478-1937
Practice Address - Street 1:102 CATHERINE LN STE A
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5701
Practice Address - Country:US
Practice Address - Phone:530-478-1933
Practice Address - Fax:530-478-1937
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG488YMedicare PIN