Provider Demographics
NPI:1588859367
Name:BINENSTOCK, MEAGAN M (PT)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:M
Last Name:BINENSTOCK
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 1:43 MAIN ST SE STE 223
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1032
Mailing Address - Country:US
Mailing Address - Phone:612-331-5757
Mailing Address - Fax:612-331-7557
Practice Address - Street 1:2119 CLIFF RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2345
Practice Address - Country:US
Practice Address - Phone:651-688-7500
Practice Address - Fax:651-688-7070
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist