Basic Information
| Provider Information | |||||||||
| NPI: | 1407490386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANUSA | ||||||||
| FirstName: | MEGHAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061071926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604094595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 PROSPECT ST STE 116 | ||||||||
| Address2: | |||||||||
| City: | NAUGATUCK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067703075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037230722 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2019 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12508 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.