Provider Demographics
NPI:1609577352
Name:FLANNERY, MEGAN JANE (PTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANE
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 POOCHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03466-3517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:136 ARCH ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2186
Practice Address - Country:US
Practice Address - Phone:603-357-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9324225200000X
VT041.0133958225200000X
NH1456225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant