Provider Demographics
NPI:1144743865
Name:MELTON, MICHAEL A (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MELTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 OAK STREET EXT.
Mailing Address - Street 2:SUITE 145
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-3539
Mailing Address - Country:US
Mailing Address - Phone:828-245-5003
Mailing Address - Fax:828-245-5798
Practice Address - Street 1:247 OAK ST STE 145
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-4909
Practice Address - Country:US
Practice Address - Phone:828-245-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17259225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist