Provider Demographics
NPI:1982678892
Name:ESCALANTE, MELISSA SUZANNE (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUZANNE
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUZANNE
Other - Last Name:GOEHRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:LAPINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739
Mailing Address - Country:US
Mailing Address - Phone:541-536-9121
Mailing Address - Fax:541-536-6123
Practice Address - Street 1:51681 HUNTINGTON ROAD
Practice Address - Street 2:
Practice Address - City:LAPINE
Practice Address - State:OR
Practice Address - Zip Code:97739
Practice Address - Country:US
Practice Address - Phone:541-536-6122
Practice Address - Fax:541-536-6123
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113802Medicare ID - Type Unspecified
113906Medicare ID - Type Unspecified