Provider Demographics
NPI:1083802409
Name:EMBREE, MELANIE ANDREA (PT, OCS, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANDREA
Last Name:EMBREE
Suffix:
Gender:F
Credentials:PT, OCS, CSCS
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:ANDREA
Other - Last Name:FORSYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:19134 CURRIER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-639-9770
Mailing Address - Fax:541-919-1839
Practice Address - Street 1:19134 CURRIER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-639-9770
Practice Address - Fax:541-919-1839
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X, 2251X0800X
WAPT00008184225100000X
OR3932225100000X
OR039322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR156839Medicare PIN
OR0230952Medicaid