Provider Demographics
NPI:1689869661
Name:CARLSON, MELINDA PERRY (DPT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:PERRY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:PERRY
Other - Last Name:BRANCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:IMPACT THERAPY SOLUTIONS
Mailing Address - Street 2:201 PALOMA DR.
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502
Mailing Address - Country:US
Mailing Address - Phone:254-892-0527
Mailing Address - Fax:254-852-4959
Practice Address - Street 1:201 PALOMA DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2211
Practice Address - Country:US
Practice Address - Phone:254-892-0527
Practice Address - Fax:254-853-4959
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist