Provider Demographics
NPI:1922524693
Name:LI, MELISSA LAI (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAI
Last Name:LI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:504 MALLORY AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8884
Mailing Address - Country:US
Mailing Address - Phone:707-228-6892
Mailing Address - Fax:
Practice Address - Street 1:3975 OLD REDWOOD HWY
Practice Address - Street 2:MEDICAL OFFICE BUILDING 5, SUITE 152
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1719
Practice Address - Country:US
Practice Address - Phone:707-566-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist