Provider Demographics
NPI:1366650780
Name:PROCHAZKA, MEGHANN NOEL (BA, MS)
Entity Type:Individual
Prefix:
First Name:MEGHANN
Middle Name:NOEL
Last Name:PROCHAZKA
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 S MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3202
Practice Address - Country:US
Practice Address - Phone:410-676-6767
Practice Address - Fax:410-676-6770
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25879225100000X
PAPT029408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00817738OtherRRMCR
NJP00817738OtherRRMCR
NJ163263V2NMedicare PIN