Provider Demographics
NPI:1053527416
Name:CARLSON, MELISSA MUCHMORE (DPT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MUCHMORE
Last Name:CARLSON
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 1:30 BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2813
Mailing Address - Country:US
Mailing Address - Phone:617-932-1776
Mailing Address - Fax:
Practice Address - Street 1:1 DOVE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2944
Practice Address - Country:US
Practice Address - Phone:978-745-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH 16191-PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist