Provider Demographics
NPI:1427399591
Name:MELESE, ANNIQUE NOELLE (PT, DPT, CSCS)
Entity type:Individual
Prefix:MS
First Name:ANNIQUE
Middle Name:NOELLE
Last Name:MELESE
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11468 SORRENTO VALLEY RD
Mailing Address - Street 2:STE. A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1347
Mailing Address - Country:US
Mailing Address - Phone:650-906-4132
Mailing Address - Fax:
Practice Address - Street 1:11468 SORRENTO VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1347
Practice Address - Country:US
Practice Address - Phone:858-457-3545
Practice Address - Fax:858-457-0976
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39922225100000X
CAPT39922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4091491Medicare UPIN
CA95-4091491Medicaid
CA95-4091491Medicare PIN