1295080075 NPI number — DR. MEGAN ELIZABETH RICHEY PASS PT, DPT

Table of content: DR. MEGAN ELIZABETH RICHEY PASS PT, DPT (NPI 1295080075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295080075 NPI number — DR. MEGAN ELIZABETH RICHEY PASS PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASS
Provider First Name:
MEGAN
Provider Middle Name:
ELIZABETH RICHEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHEY
Provider Other First Name:
MEGAN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295080075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11971 JAMES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-898-0879
Provider Business Mailing Address Fax Number:
844-377-2251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11971 JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-345-3778
Provider Business Practice Location Address Fax Number:
855-670-0383
Provider Enumeration Date:
07/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501301954 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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