Provider Demographics
NPI:1346509577
Name:BEAN, MELANIE C (MSPT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:C
Last Name:BEAN
Suffix:
Gender:F
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3830
Mailing Address - Country:US
Mailing Address - Phone:805-217-7330
Mailing Address - Fax:714-960-7486
Practice Address - Street 1:522 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-3830
Practice Address - Country:US
Practice Address - Phone:805-217-7330
Practice Address - Fax:714-960-7486
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38771225100000X
CA20000007582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer