Healthcare Provider Details

I. General information

NPI: 1235320144
Provider Name (Legal Business Name): MEGHAN NIKONCHUK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 NORTH AVE
BURLINGTON VT
05408-2751
US

IV. Provider business mailing address

1205 NORTH AVE
BURLINGTON VT
05408-2751
US

V. Phone/Fax

Practice location:
  • Phone: 802-383-0400
  • Fax: 802-383-0420
Mailing address:
  • Phone: 802-383-0400
  • Fax: 802-383-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number040-0003738
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: