Provider Demographics
NPI:1881606317
Name:JOHNS, MELISSA M (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:JOHNS
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 1:101 HODENCAMP ROAD, STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-495-0516
Mailing Address - Fax:805-381-9366
Practice Address - Street 1:101 HODENCAMP ROAD
Practice Address - Street 2:STE 100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-495-0516
Practice Address - Fax:805-381-9366
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17596174400000X
CAPT34718174400000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic