Provider Demographics
NPI:1003084906
Name:HARDISTY, MEGAN SEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:SEAN
Last Name:HARDISTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1829 EAST FRANKLIN STREET
Mailing Address - Street 2:BLDG. # 600
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27214
Mailing Address - Country:US
Mailing Address - Phone:919-968-3456
Mailing Address - Fax:919-932-3456
Practice Address - Street 1:4201 LAKE BOONE TRAIL SUITE 4
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7511
Practice Address - Country:US
Practice Address - Phone:919-968-3456
Practice Address - Fax:919-932-3456
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11412225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist