Provider Demographics
NPI:1932641578
Name:FUCCELLA, MEGHAN ANGELA (PT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANGELA
Last Name:FUCCELLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 FOLSOM BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5354
Mailing Address - Country:US
Mailing Address - Phone:916-455-5524
Mailing Address - Fax:916-455-5584
Practice Address - Street 1:3401 FOLSOM BLVD STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5354
Practice Address - Country:US
Practice Address - Phone:916-455-5524
Practice Address - Fax:916-455-5584
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist