Healthcare Provider Details

I. General information

NPI: 1750722492
Provider Name (Legal Business Name): MEAGAN NICOLE RICHARDSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SODOM RD
HEBRON ME
04238-3319
US

IV. Provider business mailing address

43 SODOM RD
HEBRON ME
04238-3319
US

V. Phone/Fax

Practice location:
  • Phone: 207-966-1239
  • Fax:
Mailing address:
  • Phone: 207-966-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA2819
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: