Provider Demographics
NPI:1720094428
Name:GRECO, MEGAN MALLOY (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MALLOY
Last Name:GRECO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 COTSWOLD SPRING FARM LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2029
Mailing Address - Country:US
Mailing Address - Phone:435-794-6344
Mailing Address - Fax:
Practice Address - Street 1:11320 COTSWOLD SPRING FARM LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2029
Practice Address - Country:US
Practice Address - Phone:443-579-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216532Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER