Provider Demographics
NPI:1124334057
Name:PELUSO, MEAGAN (PT)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:PELUSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 LAFAYETTE ST STE K&L
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3202
Mailing Address - Country:US
Mailing Address - Phone:334-791-5865
Mailing Address - Fax:
Practice Address - Street 1:4540 LAFAYETTE ST STE K&L
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3202
Practice Address - Country:US
Practice Address - Phone:334-791-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist