Provider Demographics
NPI:1255420154
Name:CARLTON, MELISSA FOLEY (PT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FOLEY
Last Name:CARLTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2669 NE TWIN KNOLLS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4895
Mailing Address - Country:US
Mailing Address - Phone:541-241-0223
Mailing Address - Fax:855-564-1873
Practice Address - Street 1:2669 NE TWIN KNOLLS DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4895
Practice Address - Country:US
Practice Address - Phone:541-241-0223
Practice Address - Fax:855-564-1873
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61021225100000X
CAPT27659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500685935Medicaid
OR500685935Medicaid