Provider Demographics
NPI:1598073397
Name:FRUCHTENICHT, MEREDITH LESLIE ERIN
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LESLIE ERIN
Last Name:FRUCHTENICHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 OLD CROW CANYON RD
Mailing Address - Street 2:BUILDING 100 SUITE 112
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 OLD CROW CANYON RD
Practice Address - Street 2:BUILDING 100 SUITE 112
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1623
Practice Address - Country:US
Practice Address - Phone:925-362-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT267752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics