Provider Demographics
NPI:1235320144
Name:NIKONCHUK, MEGHAN (DPT)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:
Last Name:NIKONCHUK
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 1:1205 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2751
Mailing Address - Country:US
Mailing Address - Phone:802-383-0400
Mailing Address - Fax:802-383-0420
Practice Address - Street 1:1205 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2751
Practice Address - Country:US
Practice Address - Phone:802-383-0400
Practice Address - Fax:802-383-0420
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-00037382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic