Provider Demographics
NPI:1023529609
Name:FROISETH, MEGHAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:FROISETH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2142 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4142
Mailing Address - Country:US
Mailing Address - Phone:718-819-6800
Mailing Address - Fax:929-381-1014
Practice Address - Street 1:74 COMMERCE AVE STE 3
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3105
Practice Address - Country:US
Practice Address - Phone:631-339-9110
Practice Address - Fax:631-339-9004
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021835OtherLICENSE