Provider Demographics
NPI:1558509844
Name:SANDEN, MELISSA RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:SANDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RENEE
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1266 TAMSON DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428
Mailing Address - Country:US
Mailing Address - Phone:805-924-1605
Mailing Address - Fax:805-924-1603
Practice Address - Street 1:1266 TAMSON DR
Practice Address - Street 2:STE 101
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428
Practice Address - Country:US
Practice Address - Phone:805-924-1605
Practice Address - Fax:805-924-1603
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist