Provider Demographics
NPI:1053400572
Name:ANDERSON, MELINDA YVONNE WOOLF (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:YVONNE WOOLF
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3278 BECHELLI LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2005
Mailing Address - Country:US
Mailing Address - Phone:530-223-9474
Mailing Address - Fax:
Practice Address - Street 1:3278 BECHELLI LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2005
Practice Address - Country:US
Practice Address - Phone:530-223-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 170382251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT17038OtherCA PT LICENSE NO.
CA0PT170380Medicare PIN