Provider Demographics
NPI:1932705076
Name:SKOVORODKO, MELISSA GRACE (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:SKOVORODKO
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 1:137 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4907
Mailing Address - Country:US
Mailing Address - Phone:408-315-8537
Mailing Address - Fax:
Practice Address - Street 1:16899 W BERNARDO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1603
Practice Address - Country:US
Practice Address - Phone:858-521-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist