Provider Demographics
NPI:1992936462
Name:CHURCH, MEGHAN MARIE (PT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MARIE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:MARIE
Other - Last Name:PARCHEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:720 MASSACHUSETTS AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3324
Mailing Address - Country:US
Mailing Address - Phone:425-231-3179
Mailing Address - Fax:
Practice Address - Street 1:720 MASSACHUSETTS AVE APT 5
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3324
Practice Address - Country:US
Practice Address - Phone:425-231-3179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist