Provider Demographics
NPI:1851571285
Name:KANAN, MELISSA ANNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:KANAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:LEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1531 HAWES CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2723
Mailing Address - Country:US
Mailing Address - Phone:650-362-3377
Mailing Address - Fax:
Practice Address - Street 1:3532 ALAMEDA
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6510
Practice Address - Country:US
Practice Address - Phone:650-561-9589
Practice Address - Fax:650-561-9654
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06783ZMedicare PIN
CACA116362Medicare PIN