Provider Demographics
NPI:1124244769
Name:CONNELL, MELANIE WHEELER (MPT, MTC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:WHEELER
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17332 VON KARMAN AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6282
Mailing Address - Country:US
Mailing Address - Phone:949-861-8600
Mailing Address - Fax:949-861-8601
Practice Address - Street 1:1700 ADAMS AVE STE 201
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4865
Practice Address - Country:US
Practice Address - Phone:714-556-1600
Practice Address - Fax:714-556-3737
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37253225100000X
FL19488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist