Provider Demographics
NPI:1295168987
Name:CORRIVEAU, MEAGAN M (PT,DPT)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:M
Last Name:CORRIVEAU
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:C
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1145 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1529
Mailing Address - Country:US
Mailing Address - Phone:708-386-2086
Mailing Address - Fax:708-386-3028
Practice Address - Street 1:1145 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1529
Practice Address - Country:US
Practice Address - Phone:708-386-2086
Practice Address - Fax:708-386-3028
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-020023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist