Provider Demographics
NPI:1316915234
Name:SMITH, MEGAN L (PT)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:L
Other - Last Name:THURBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-942-2625
Mailing Address - Fax:401-942-3097
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-942-2625
Practice Address - Fax:401-942-3097
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist