Provider Demographics
NPI:1467630822
Name:WESSMAN, MEGAN LEE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEE
Last Name:WESSMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:LEE
Other - Last Name:ROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8881 ROUTE 97
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723
Mailing Address - Country:US
Mailing Address - Phone:458-333-6882
Mailing Address - Fax:845-887-4656
Practice Address - Street 1:8881 ROUTE 97
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723
Practice Address - Country:US
Practice Address - Phone:845-333-6882
Practice Address - Fax:845-887-4656
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029966225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029966OtherSTATE LICENSE