Provider Demographics
NPI:1558765651
Name:CARMAN, MELISSA (MPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 SPRING RAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-6700
Mailing Address - Country:US
Mailing Address - Phone:636-443-9185
Mailing Address - Fax:
Practice Address - Street 1:1159 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4704
Practice Address - Country:US
Practice Address - Phone:970-460-0066
Practice Address - Fax:970-460-0136
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00137692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL.0013769OtherCOLORADO PT LICENSE
IL070017409OtherSTATE OF ILLINOIS LICENSED PHYSICAL THERAPIST