Provider Demographics
NPI:1134621584
Name:WILDASIN, MEAGHAN EILEEN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:EILEEN
Last Name:WILDASIN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:EILEEN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:750 MENGES MILLS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-9181
Mailing Address - Country:US
Mailing Address - Phone:908-507-1868
Mailing Address - Fax:
Practice Address - Street 1:1800 BANNISTER ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4917
Practice Address - Country:US
Practice Address - Phone:717-817-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0000962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer