Provider Demographics
NPI:1881847986
Name:CARNEVALE, MEGAN DANIELLE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:DANIELLE
Last Name:CARNEVALE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:DANIELLE
Other - Last Name:DISANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:159 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2045
Mailing Address - Country:US
Mailing Address - Phone:315-342-9575
Mailing Address - Fax:315-342-7664
Practice Address - Street 1:1529 NYE RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-9111
Practice Address - Country:US
Practice Address - Phone:315-946-5673
Practice Address - Fax:315-946-5850
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026494-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist