Healthcare Provider Details

I. General information

NPI: 1982152195
Provider Name (Legal Business Name): MEAGAN MARTIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEAGAN JACKSON

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 CENTER ST STE B
MOBILE AL
36604-1512
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1670
  • Fax: 251-415-1671
Mailing address:
  • Phone: 251-415-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH8086
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: