Basic Information
| Provider Information | |||||||||
| NPI: | 1851549109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | MEGHAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 PATRICIA M. GENOVA DRIVE | ||||||||
| Address2: | EASTERN REHABILITATION NETWORK 5TH FLOOR | ||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606675480 | ||||||||
| FaxNumber: | 8606678416 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 EAST GRANBY ROAD | ||||||||
| Address2: | |||||||||
| City: | GRANBY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606532301 | ||||||||
| FaxNumber: | 8606357875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 08/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 000931 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.