Provider Demographics
NPI:1679579049
Name:VAN DONGEN, MEGHAN MICHELLE
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MICHELLE
Last Name:VAN DONGEN
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 1:6007 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3140
Mailing Address - Country:US
Mailing Address - Phone:615-945-0666
Mailing Address - Fax:
Practice Address - Street 1:555 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-1109
Practice Address - Country:US
Practice Address - Phone:202-347-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7142225100000X
DCPT871077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist