Provider Demographics
NPI:1023590791
Name:HYDE, MEGHAN LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LYNN
Last Name:HYDE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:LYNN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7825 3RD ST N
Mailing Address - Street 2:STE 105
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5444
Mailing Address - Country:US
Mailing Address - Phone:952-835-4512
Mailing Address - Fax:888-425-0398
Practice Address - Street 1:9225 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5501
Practice Address - Country:US
Practice Address - Phone:877-609-0123
Practice Address - Fax:888-425-0398
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34308225100000X
NY043093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist