Provider Demographics
NPI:1659920874
Name:BORAN, MEGHAN MARIE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:MARIE
Last Name:BORAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1465
Mailing Address - Country:US
Mailing Address - Phone:570-501-1808
Mailing Address - Fax:855-635-6308
Practice Address - Street 1:1077 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1465
Practice Address - Country:US
Practice Address - Phone:570-501-1808
Practice Address - Fax:855-635-6308
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027950208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation