Active NPI
Melissa Leo Braucht, PT
- Physical Therapist
- San Dimas, CA
National Provider Identifier
1528325941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 38741
- Practice address
- 1335 Cypress St
Suite 100
San Dimas, CA 91773-3537 - Phone
- (909) 305-1383
- Fax
- (909) 305-1435
- NPI assigned
- Apr 23, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 38741 | CA | Primary |
Addresses
Primary practice location
1335 Cypress St
Suite 100
San Dimas, CA 91773-3537
Mailing address
11588 Santa Anita Ave
Chino, CA 91710-1980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38741 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Covina Hills Sports Medicine Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- San Dimas, CA
- NPI 1154369213
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335139200000",
"number": "1528325941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11588 SANTA ANITA AVE",
"city": "CHINO",
"state": "CA",
"postal_code": "917101980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1335 CYPRESS ST",
"address_2": "SUITE 100",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917733537",
"telephone_number": "909-305-1383",
"fax_number": "909-305-1435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAUCHT",
"first_name": "MELISSA",
"middle_name": "LEO",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-23",
"last_updated": "2012-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "38741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Dimas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.