MEDICARE: MEGAN LAUREL WILLERTON M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2005013034	MO

General Provider Information

NPI Number	:	1528282209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN LAUREL WILLERTON M.P.T.

Provider Business Mailing Address
First Line	:	1627 CARROLL ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-3347
Country	:	US
Telephone Number	:	314-494-8167
Fax Number	:

Provider Business Practice Location Address
First Line	:	2127 INNERBELT BUSINESS CENTER DR
Second Line	:	SUITE 115
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-5700
Country	:	US
Telephone Number	:	314-426-7006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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