Provider Demographics
NPI:1144762949
Name:DELLAQUILA MEEHAN, PHYLISSA (DPT)
Entity Type:Individual
Prefix:
First Name:PHYLISSA
Middle Name:
Last Name:DELLAQUILA MEEHAN
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 1:11 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKHOLM
Mailing Address - State:NJ
Mailing Address - Zip Code:07460-1816
Mailing Address - Country:US
Mailing Address - Phone:973-986-8749
Mailing Address - Fax:
Practice Address - Street 1:11 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:STOCKHOLM
Practice Address - State:NJ
Practice Address - Zip Code:07460-1816
Practice Address - Country:US
Practice Address - Phone:973-986-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01611200225100000X
FLPT25316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist