Provider Demographics
NPI:1497206106
Name:VESELY, MEGHAN ROSE (PT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ROSE
Last Name:VESELY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ROSE
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 STOWE ROAD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012
Mailing Address - Country:US
Mailing Address - Phone:914-588-1276
Mailing Address - Fax:
Practice Address - Street 1:2675 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1478
Practice Address - Country:US
Practice Address - Phone:704-824-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16544225100000X
NCPT16544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist