Provider Demographics
NPI:1508107194
Name:ZULLO, MEGHAN (DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:ZULLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:TRULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 JUSTISON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5150
Practice Address - Country:US
Practice Address - Phone:302-351-0302
Practice Address - Fax:630-759-9510
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP01368786Medicare PIN