Provider Demographics
NPI:1588734776
Name:RASSAM, MEREDITH PATRICK (PT, MSPT, MS)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:PATRICK
Last Name:RASSAM
Suffix:
Gender:F
Credentials:PT, MSPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROUTE 31 SOUTH
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534
Mailing Address - Country:US
Mailing Address - Phone:717-685-9548
Mailing Address - Fax:
Practice Address - Street 1:7 ROUTE 31 SOUTH
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534
Practice Address - Country:US
Practice Address - Phone:717-685-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01143000225100000X
MAMA16689225100000X
CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
099200PY9Medicare ID - Type Unspecified