Provider Demographics
NPI:1831268739
Name:GARVEY, MELINDA GUNTER (PT)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:GUNTER
Last Name:GARVEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2919
Mailing Address - Country:US
Mailing Address - Phone:310-426-9570
Mailing Address - Fax:
Practice Address - Street 1:111 PENN ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3908
Practice Address - Country:US
Practice Address - Phone:310-426-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66790ZOtherBLUE SHIELD GROUP NUMBER
CAZZZ66790ZOtherBLUE SHIELD GROUP NUMBER
CAWPT18015CMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE