Provider Demographics
NPI:1699059881
Name:MCCONVILLE-MONTANO, MEGHAN (MSPT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:MCCONVILLE-MONTANO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:MCCONVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5473
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:844-912-8608
Practice Address - Street 1:204 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-237-1769
Practice Address - Fax:781-239-9965
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008369225100000X
MA19019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist