Provider Demographics
NPI:1538715362
Name:DOOLEY, MELISSA MARIE (PT,DPT,ATC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:PT,DPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 S HOBART BLVD APT 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-5508
Mailing Address - Country:US
Mailing Address - Phone:909-231-5635
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 407
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4669
Practice Address - Country:US
Practice Address - Phone:323-917-5194
Practice Address - Fax:323-917-5196
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty