MEDICARE: SEAN MEEHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	31460	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083065247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MEEHAN

Provider Business Mailing Address
First Line	:	105 STRAW POND WAY
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-1812
Country	:	US
Telephone Number	:	516-551-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	869 STOCKTON ST
Second Line	:	300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3590
Country	:	US
Telephone Number	:	904-388-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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Directions to “ SEAN MEEHAN ” Practice Location

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