Provider Demographics
NPI:1235724303
Name:DICOSTANZO, MEGAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DICOSTANZO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 FOXTAIL LILY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-5851
Mailing Address - Country:US
Mailing Address - Phone:860-965-5820
Mailing Address - Fax:
Practice Address - Street 1:3708 FORESTVIEW RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2391
Practice Address - Country:US
Practice Address - Phone:919-786-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist