Healthcare Provider Details

I. General information

NPI: 1427553213
Provider Name (Legal Business Name): MEGHAN LYNN ZIDONIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8836 TYLER BLVD
MENTOR OH
44060-4361
US

IV. Provider business mailing address

7948 DOVEGATE DR
MENTOR OH
44060-5988
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-9553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: