MEDICARE: MEGHAN FUGLESTAD PT

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	61459	OR

General Provider Information

NPI Number	:	1740668243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN FUGLESTAD PT

Provider Business Mailing Address
First Line	:	200 NE MOTHER JOSEPH PL STE 210
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-3295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 N CENTER COURT ST STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-2104
Country	:	US
Telephone Number	:	360-254-6161
Fax Number	:	360-803-0847

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	06/18/2026

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Directions to “ MEGHAN FUGLESTAD PT” Practice Location

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