Provider Demographics
NPI:1245439496
Name:COLTHARP, MEGHAN KATHLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:KATHLEEN
Last Name:COLTHARP
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 1:2006 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4622
Mailing Address - Country:US
Mailing Address - Phone:605-342-3110
Mailing Address - Fax:605-342-3120
Practice Address - Street 1:2006 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4622
Practice Address - Country:US
Practice Address - Phone:605-342-3110
Practice Address - Fax:605-342-3120
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist