Provider Demographics
NPI:1326031758
Name:DUGANICH, MEREDITH MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MARIE
Last Name:DUGANICH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 TUPELO LN
Mailing Address - Street 2:UNIT 4G
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-8933
Mailing Address - Country:US
Mailing Address - Phone:843-241-0556
Mailing Address - Fax:
Practice Address - Street 1:700 GARDNER LACY RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-0915
Practice Address - Country:US
Practice Address - Phone:843-236-7997
Practice Address - Fax:843-903-7536
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer