Healthcare Provider Details

I. General information

NPI: 1659834109
Provider Name (Legal Business Name): MEGHAN CASEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 371 & ROUTE 9 JUNCTION
CROWNPOINT NM
97313
US

IV. Provider business mailing address

PO BOX 1813
CROWNPOINT NM
87313-1813
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-6291
  • Fax:
Mailing address:
  • Phone: 919-619-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: