Basic Information
Provider Information
NPI: 1023765963
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZIMMERMAN
FirstName: MEGHAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
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Mailing Information
Address1: 475 ALLENDALE RD STE 206
Address2:  
City: KING OF PRUSSIA
State: PA
PostalCode: 194061495
CountryCode: US
TelephoneNumber: 8888304125
FaxNumber: 6315805222
Practice Location
Address1: 528 KIMBERTON RD
Address2:  
City: PHOENIXVILLE
State: PA
PostalCode: 194604737
CountryCode: US
TelephoneNumber: 6109336232
FaxNumber: 6109336234
Other Information
ProviderEnumerationDate: 03/09/2022
LastUpdateDate: 03/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT030273PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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