Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | PT 17038 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 17038 | CA |
NPI | 1053400572 |
---|---|
Provider Name | Mrs. Melinda Yvonne Woolf Anderson |
First Address | Redding, CA 96002-2005 |
Second Address | Redding, CA 96002-2005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 25/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT17038 | CA PT LICENSE NO. (01) | CA |