MEDICARE: MRS. MELISSA FOLEY CARLTON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	61021	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255420154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA FOLEY CARLTON PT

Provider Business Mailing Address
First Line	:	2669 NE TWIN KNOLLS DR STE 104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4895
Country	:	US
Telephone Number	:	541-241-0223
Fax Number	:	855-564-1873

Provider Business Practice Location Address
First Line	:	2669 NE TWIN KNOLLS DR STE 104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4895
Country	:	US
Telephone Number	:	541-241-0223
Fax Number	:	855-564-1873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	01/10/2023

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