Provider Demographics
NPI:1750722492
Name:RICHARDSON, MEAGAN NICOLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SODOM RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:ME
Mailing Address - Zip Code:04238-3319
Mailing Address - Country:US
Mailing Address - Phone:207-966-1239
Mailing Address - Fax:
Practice Address - Street 1:43 SODOM RD
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:ME
Practice Address - Zip Code:04238-3319
Practice Address - Country:US
Practice Address - Phone:207-966-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2819225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant