Individual provider Active NPI

Charlie Paul Mellick, PTA

  • Physical Therapy Assistant
  • Houlton, ME
National Provider Identifier
1538052527
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PA6970 Issued in ME
Practice address
98 Bangor St Ste a
Houlton, ME 04730-1603
Phone
(207) 521-0200
Fax
(207) 521-0210
NPI assigned
May 30, 2025
Last updated
May 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PA6970 ME Primary

Addresses

Primary practice location

98 Bangor St Ste a
Houlton, ME 04730-1603

Mailing address

98 Bangor St Ste a
Houlton, ME 04730-1603
Phone (207) 521-0200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PA6970MEMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
County Physical Therapy, LLC CurrentSince Jun 3, 2025 Accepting new patients

Locations

98 Bangor St
Ste A
Houlton, ME 04730
Phone (207) 521-0200

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1538052527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 BANGOR ST STE A",
            "city": "HOULTON",
            "state": "ME",
            "postal_code": "047301603",
            "telephone_number": "207-521-0200",
            "fax_number": "207-521-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 BANGOR ST STE A",
            "city": "HOULTON",
            "state": "ME",
            "postal_code": "047301603",
            "telephone_number": "207-521-0200",
            "fax_number": "207-521-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLICK",
        "first_name": "CHARLIE",
        "middle_name": "PAUL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-30",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ME",
            "license": "PA6970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houlton, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.