Basic Information
| Provider Information | |||||||||
| NPI: | 1932160793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MPT, ATC, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 NEW FIDELITY CT | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275292665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192582714 | ||||||||
| FaxNumber: | 4106484878 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 ELKTON BLVD STE 3 | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433509056 | ||||||||
| FaxNumber: | 4433509565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 01/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 005549 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT007686L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 20976 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0068377000 | 01 | PA | AMERIHEALTH UNDER IBC | OTHER | CK4276 | 01 | PA | PALMETTO GBA RR MEDICARE | OTHER | 03182100 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 18444 | 01 | PA | HEALTH AMERICA | OTHER | 332313 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 177124 | 01 | PA | MEDICARE HGS ADMINISTRATO | OTHER |