Provider Demographics
NPI:1477154292
Name:STASICA, MEGHAN RIORDAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:RIORDAN
Last Name:STASICA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E KEN PRATT BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5311
Mailing Address - Country:US
Mailing Address - Phone:720-718-5400
Mailing Address - Fax:720-718-5991
Practice Address - Street 1:1760 E KEN PRATT BLVD STE 405
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:720-718-5400
Practice Address - Fax:720-718-5991
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist