Provider Demographics
NPI:1568520625
Name:MCDONOUGH, MEGHAN RENDFREY (DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:RENDFREY
Last Name:MCDONOUGH
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 1:1930 MARLTON PIKE E
Mailing Address - Street 2:SUITE E27
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-424-6677
Mailing Address - Fax:856-489-1803
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:SUITE E27
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-424-6677
Practice Address - Fax:856-489-1803
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01096200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2270689000OtherAMERIHEALTH ID
PA2270689000OtherIND BCBS PERSONAL CHOICE
NJ081350SYQMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID