Healthcare Provider Details

I. General information

NPI: 1245140540
Provider Name (Legal Business Name): MELISSA FORTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S CHERRY ST
FLUSHING MI
48433-2020
US

IV. Provider business mailing address

209 S CHERRY ST
FLUSHING MI
48433-2020
US

V. Phone/Fax

Practice location:
  • Phone: 810-487-9733
  • Fax: 810-867-4938
Mailing address:
  • Phone: 810-487-9733
  • Fax: 810-867-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017682
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: