Healthcare Provider Details

I. General information

NPI: 1245330547
Provider Name (Legal Business Name): CATHERINE A MEEHAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE A FASSELL PT

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 STATE ROUTE 9
LAKE GEORGE NY
12845-3434
US

IV. Provider business mailing address

1340 STATE ROUTE 9
LAKE GEORGE NY
12845-3434
US

V. Phone/Fax

Practice location:
  • Phone: 518-761-6580
  • Fax:
Mailing address:
  • Phone: 518-761-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025981-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: