Provider Demographics
NPI:1619384922
Name:MINORI, MEAGHAN
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:MINORI
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 1:1051 SOUTHERN DR
Mailing Address - Street 2:UNIT 3701
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-5189
Mailing Address - Country:US
Mailing Address - Phone:919-841-7406
Mailing Address - Fax:
Practice Address - Street 1:1051 SOUTHERN DR
Practice Address - Street 2:UNIT 3701
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5189
Practice Address - Country:US
Practice Address - Phone:919-841-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer