Provider Demographics
NPI:1417383506
Name:MILLER, MELANIE CALANNO (LPTA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:CALANNO
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13953 PANAY WAY
Mailing Address - Street 2:C119
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6158
Mailing Address - Country:US
Mailing Address - Phone:310-574-1834
Mailing Address - Fax:
Practice Address - Street 1:13953 PANAY WAY
Practice Address - Street 2:C119
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6158
Practice Address - Country:US
Practice Address - Phone:310-574-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8439225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant