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NPI Code Detail

MEDICARE: MEGAN BOUDREAUX DPT

MEDICARE: MEGAN BOUDREAUX DPT
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
1225100000XPhysical TherapistPT22843FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122843OTHERFLLICENSE#

General Provider Information

NPI Number : 1902097835
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN BOUDREAUX DPT
Provider Business Mailing Address
First Line : 4016 CHASE AVE
Second Line :
City : MIAMI BEACH
State : FL
Zip : 33140-3421
Country : US
Telephone Number : 305-538-6500
Fax Number :
Provider Business Practice Location Address
First Line : 4016 CHASE AVE
Second Line :
City : MIAMI BEACH
State : FL
Zip : 33140-3421
Country : US
Telephone Number : 305-538-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2007
Last Update Date : 12/16/2024

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