Provider Demographics
NPI:1497138374
Name:FALLON, MEGHAN (DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 US ROUTE 1
Mailing Address - Street 2:UNIT 4
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5883
Mailing Address - Country:US
Mailing Address - Phone:207-351-3078
Mailing Address - Fax:207-351-3083
Practice Address - Street 1:764 US ROUTE 1
Practice Address - Street 2:UNIT 4
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-5883
Practice Address - Country:US
Practice Address - Phone:207-351-3078
Practice Address - Fax:207-351-3083
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist