Healthcare Provider Details

I. General information

NPI: 1902183932
Provider Name (Legal Business Name): MEGHAN STORNELLI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 WATERTOWN ST
WATERTOWN MA
02472-2571
US

IV. Provider business mailing address

535 S MAIN ST
RANDOLPH MA
02368-5261
US

V. Phone/Fax

Practice location:
  • Phone: 617-630-9778
  • Fax: 617-630-5202
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-767-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19756
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: