Provider Demographics
NPI:1598229619
Name:POWELL, MEGHAN THERESE (ATC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:THERESE
Last Name:POWELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 JENKINS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-9468
Mailing Address - Country:US
Mailing Address - Phone:719-351-9010
Mailing Address - Fax:
Practice Address - Street 1:1000 RIM DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-3999
Practice Address - Country:US
Practice Address - Phone:970-247-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer