Provider Demographics
NPI:1831264142
Name:PETTIT, MEGAN CATHLEEN (MS PT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:CATHLEEN
Last Name:PETTIT
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:CATHLEEN
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 HAWKINS AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:631-981-7422
Mailing Address - Fax:631-981-2490
Practice Address - Street 1:650 HAWKINS AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11780
Practice Address - Country:US
Practice Address - Phone:631-981-7422
Practice Address - Fax:631-981-2490
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0209701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist