Provider Demographics
NPI:1811304827
Name:CHENG, MELANIE TIU (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:TIU
Last Name:CHENG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 DWIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-3843
Mailing Address - Country:US
Mailing Address - Phone:310-293-4646
Mailing Address - Fax:
Practice Address - Street 1:11848 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE #100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2416
Practice Address - Country:US
Practice Address - Phone:310-293-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist