Provider Demographics
NPI:1164202792
Name:REYNOLDS, MEGHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-7402
Mailing Address - Country:US
Mailing Address - Phone:518-588-8185
Mailing Address - Fax:
Practice Address - Street 1:820 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1766
Practice Address - Country:US
Practice Address - Phone:518-289-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050989-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist