=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831523521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEAGAN DENISE RICHARDS PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2013
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 N STATE ST STE 5
-----------------------------------------------------
City | SHELLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83274-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-428-6079
-----------------------------------------------------
Fax | 208-209-6079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 N STATE ST STE 5
-----------------------------------------------------
City | SHELLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83274-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-428-6079
-----------------------------------------------------
Fax | 208-209-6079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 041660-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT60401857
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | P21111
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 8161078
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------