MEDICARE: MS. MEGHAN NIKONCHUK DPT

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	2251X0800X	Orthopedic Physical Therapist	040-0003738	VT

General Provider Information

NPI Number	:	1235320144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEGHAN NIKONCHUK DPT

Provider Business Mailing Address
First Line	:	1205 NORTH AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05408-2751
Country	:	US
Telephone Number	:	802-383-0400
Fax Number	:	802-383-0420

Provider Business Practice Location Address
First Line	:	1205 NORTH AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05408-2751
Country	:	US
Telephone Number	:	802-383-0400
Fax Number	:	802-383-0420

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	09/26/2022

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