MEDICARE: MEGAN MERCADO

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
2	225100000X	Physical Therapist	9805	CO

General Provider Information

NPI Number	:	1568541639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MERCADO

Provider Business Mailing Address
First Line	:	6097 W PROGRESS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80123-5101
Country	:	US
Telephone Number	:	720-302-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 UNION BLVD STE 110
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1833
Country	:	US
Telephone Number	:	303-232-0355
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	10/05/2009

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Directions to “ MEGAN MERCADO ” Practice Location

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