Provider Demographics
NPI:1235320623
Name:CARVELL, MELANIE ANN (PT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:CARVELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1214
Mailing Address - Country:US
Mailing Address - Phone:701-323-6376
Mailing Address - Fax:701-323-6347
Practice Address - Street 1:1100 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1214
Practice Address - Country:US
Practice Address - Phone:701-323-6376
Practice Address - Fax:701-323-6347
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist