Provider Demographics
NPI:1841804861
Name:HESKETH, MEGHAN (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:HESKETH
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2384
Mailing Address - Country:US
Mailing Address - Phone:781-924-6365
Mailing Address - Fax:781-924-3454
Practice Address - Street 1:645 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2384
Practice Address - Country:US
Practice Address - Phone:781-924-6365
Practice Address - Fax:781-924-3454
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist