Provider Demographics
NPI:1609301951
Name:MEINCKE, DEBORAH JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:MEINCKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:55 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1427
Mailing Address - Country:US
Mailing Address - Phone:781-326-0683
Mailing Address - Fax:
Practice Address - Street 1:55 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1427
Practice Address - Country:US
Practice Address - Phone:781-326-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist