Healthcare Provider Details

I. General information

NPI: 1851549109
Provider Name (Legal Business Name): MEGHAN GARRETT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 EAST GRANBY ROAD
GRANBY CT
06035
US

IV. Provider business mailing address

181 PATRICIA M. GENOVA DRIVE EASTERN REHABILITATION NETWORK 5TH FLOOR
NEWINGTON CT
06111
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-2301
  • Fax: 860-635-7875
Mailing address:
  • Phone: 860-667-5480
  • Fax: 860-667-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000931
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: