Provider Demographics
NPI:1568152866
Name:CARLISLE, MEGHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:CARLISLE
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 1:676 N SAINT CLAIR ST STE 950
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2955
Mailing Address - Country:US
Mailing Address - Phone:312-694-7337
Mailing Address - Fax:312-695-0156
Practice Address - Street 1:676 N SAINT CLAIR ST STE 950
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2955
Practice Address - Country:US
Practice Address - Phone:312-694-7337
Practice Address - Fax:312-695-0156
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IL070027444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist