Provider Demographics
NPI:1396210712
Name:HAFER, MELODY ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ROSE
Last Name:HAFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 TERRELL DR APT 1
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-5541
Mailing Address - Country:US
Mailing Address - Phone:559-908-2525
Mailing Address - Fax:
Practice Address - Street 1:3350 WATT AVE STE G
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3618
Practice Address - Country:US
Practice Address - Phone:916-483-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist