Provider Demographics
NPI:1316216849
Name:COPELAND, MEGHAN KENNEDY (PT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KENNEDY
Last Name:COPELAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MULBERRY POINT RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3523
Mailing Address - Country:US
Mailing Address - Phone:293-457-7989
Mailing Address - Fax:
Practice Address - Street 1:809 NEW HAVEN RD
Practice Address - Street 2:#R
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-2412
Practice Address - Country:US
Practice Address - Phone:860-349-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist