Provider Demographics
NPI:1609039221
Name:SEDILLA, MELANY KAREN BALAY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MELANY KAREN
Middle Name:BALAY
Last Name:SEDILLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 NATIONAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2637
Mailing Address - Country:US
Mailing Address - Phone:408-358-3631
Mailing Address - Fax:
Practice Address - Street 1:14901 NATIONAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2637
Practice Address - Country:US
Practice Address - Phone:408-358-3631
Practice Address - Fax:408-358-4537
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8752225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant