Provider Demographics
NPI:1831061902
Name:WILSON, MEGHAN
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:FRINK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:101 W BROADWAY ST APT 422
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-9348
Mailing Address - Country:US
Mailing Address - Phone:651-408-5094
Mailing Address - Fax:
Practice Address - Street 1:23212 MN-47 S
Practice Address - Street 2:STE 300
Practice Address - City:ST. FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070
Practice Address - Country:US
Practice Address - Phone:763-753-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist