Provider Demographics
NPI:1659099182
Name:SARMIENTO, MEAGAN ALLISON (PT)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ALLISON
Last Name:SARMIENTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:ALLISON
Other - Last Name:MARCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1640 KEPLER BND
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6906
Mailing Address - Country:US
Mailing Address - Phone:757-754-0719
Mailing Address - Fax:
Practice Address - Street 1:12250 EL CAMINO REAL STE 190
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2298
Practice Address - Country:US
Practice Address - Phone:858-793-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist