Provider Demographics
NPI:1912885807
Name:MEEHAN, DYLAN THOMAS
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:THOMAS
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 N 61ST AVE APT 2076
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-6768
Mailing Address - Country:US
Mailing Address - Phone:909-213-8957
Mailing Address - Fax:
Practice Address - Street 1:8150 N 61ST AVE APT 2076
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-6768
Practice Address - Country:US
Practice Address - Phone:909-213-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ087311227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered