Provider Demographics
NPI:1881047827
Name:VICENCIO, MELINDA (DPT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:VICENCIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:RIENAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:680 W NYE LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1575
Mailing Address - Country:US
Mailing Address - Phone:775-882-2211
Mailing Address - Fax:
Practice Address - Street 1:680 W NYE LN
Practice Address - Street 2:SUITE 205
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1575
Practice Address - Country:US
Practice Address - Phone:775-882-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist