Provider Demographics
NPI:1457907891
Name:LONG, MEGHAN (DPT)
Entity type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 S QUEBEC ST
Mailing Address - Street 2:STE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2010
Mailing Address - Country:US
Mailing Address - Phone:303-887-0870
Mailing Address - Fax:303-770-0871
Practice Address - Street 1:4366 KUKUI GROVE ST STE 203
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2006
Practice Address - Country:US
Practice Address - Phone:808-246-0144
Practice Address - Fax:808-245-5148
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016483225100000X
HI4869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist