Provider Demographics
NPI:1902146905
Name:THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIQUE
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:MELESE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:650-906-4132
Mailing Address - Street 1:3760 CONVOY ST
Mailing Address - Street 2:SUITE#204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3742
Mailing Address - Country:US
Mailing Address - Phone:858-514-0375
Mailing Address - Fax:
Practice Address - Street 1:2211 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-3616
Practice Address - Country:US
Practice Address - Phone:619-698-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty