Provider Demographics
NPI:1073537965
Name:RADOCY, MEGHAN A (DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:A
Last Name:RADOCY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 OAKWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8595
Mailing Address - Country:US
Mailing Address - Phone:253-304-5151
Mailing Address - Fax:
Practice Address - Street 1:820 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2469
Practice Address - Country:US
Practice Address - Phone:231-487-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862740OtherMEDICARE ID