Provider Demographics
NPI:1023357373
Name:GAUCHER, MEREDITH (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:
Last Name:GAUCHER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:WOLANIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1971 WESTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5066
Mailing Address - Country:US
Mailing Address - Phone:518-869-6220
Mailing Address - Fax:
Practice Address - Street 1:1971 WESTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-869-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist