Provider Demographics
NPI:1841997137
Name:MENGES, CAROLYN VIRGINIA (DPT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:VIRGINIA
Last Name:MENGES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROBERTS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2880
Mailing Address - Country:US
Mailing Address - Phone:440-478-9543
Mailing Address - Fax:
Practice Address - Street 1:1601 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2102
Practice Address - Country:US
Practice Address - Phone:207-774-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT64552251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics