Provider Demographics
NPI:1144577222
Name:SMITH, MEGHAN DIONNDRA (DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:DIONNDRA
Last Name:SMITH
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 1:1801 BRANTLEY ROAD #905
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3994
Mailing Address - Country:US
Mailing Address - Phone:256-603-2826
Mailing Address - Fax:
Practice Address - Street 1:1750 WILCO RD
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1085
Practice Address - Country:US
Practice Address - Phone:503-769-7131
Practice Address - Fax:503-769-7132
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1272898225100000X
FLPT27133225100000X
OR63310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist