Provider Demographics
NPI:1184016818
Name:POVEROMO, MEGHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:POVEROMO
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 1:195 STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2413
Mailing Address - Country:US
Mailing Address - Phone:716-228-8564
Mailing Address - Fax:
Practice Address - Street 1:195 STERLING AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2413
Practice Address - Country:US
Practice Address - Phone:716-228-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1252217225100000X
NM4571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist