Provider Demographics
NPI:1598826125
Name:ROURKE, MEAGHAN (ATC)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:ROURKE
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 1:9894 FOX AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1321
Mailing Address - Country:US
Mailing Address - Phone:313-363-4856
Mailing Address - Fax:
Practice Address - Street 1:9894 FOX AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1321
Practice Address - Country:US
Practice Address - Phone:313-363-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer