Provider Demographics
NPI:1467158949
Name:TIDEY, MEGAN NICOLE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:NICOLE
Last Name:TIDEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6565 N CHARLES ST STE 601
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5801
Mailing Address - Country:US
Mailing Address - Phone:410-823-8061
Mailing Address - Fax:443-901-3099
Practice Address - Street 1:30 E PADONIA RD STE 104
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2347
Practice Address - Country:US
Practice Address - Phone:410-823-8061
Practice Address - Fax:443-901-3099
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist