Provider Demographics
NPI:1932483112
Name:JOHNSON, MELINDA WENDLING (PT)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:WENDLING
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:DENISE
Other - Last Name:WENDLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12754 VIA GRIMALDI
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3808
Mailing Address - Country:US
Mailing Address - Phone:858-354-5842
Mailing Address - Fax:888-336-3381
Practice Address - Street 1:12754 VIA GRIMALDI
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3808
Practice Address - Country:US
Practice Address - Phone:858-354-5842
Practice Address - Fax:858-792-5842
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist