Provider Demographics
NPI:1255515284
Name:GOLDE, MELISSA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:GOLDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 15TH STREET
Mailing Address - Street 2:SUITE 407
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-393-9292
Mailing Address - Fax:310-393-6693
Practice Address - Street 1:1304 15TH STREET
Practice Address - Street 2:SUITE 407
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-393-9292
Practice Address - Fax:310-393-6693
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist