Healthcare Provider Details

I. General information

NPI: 1952843583
Provider Name (Legal Business Name): MEAGHAN TANGUAY WHITE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGHAN TANGUAY

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N MEADOWS RD
MEDFIELD MA
02052-2317
US

IV. Provider business mailing address

471 CHESTNUT ST
NEEDHAM MA
02492-2822
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-9119
  • Fax: 508-359-9115
Mailing address:
  • Phone: 506-667-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22404
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: