Provider Demographics
NPI:1336383132
Name:MEAGLEY, CHAD MICHAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:MICHAEL
Last Name:MEAGLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 1 OLD NANTICOKE RD
Mailing Address - Street 2:
Mailing Address - City:MAINE
Mailing Address - State:NY
Mailing Address - Zip Code:13802-0000
Mailing Address - Country:US
Mailing Address - Phone:607-323-5119
Mailing Address - Fax:
Practice Address - Street 1:61 1 OLD NANTICOKE RD
Practice Address - Street 2:
Practice Address - City:MAINE
Practice Address - State:NY
Practice Address - Zip Code:13802-0000
Practice Address - Country:US
Practice Address - Phone:607-323-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008277225200000X
NY005926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant