Healthcare Provider Details

I. General information

NPI: 1750150850
Provider Name (Legal Business Name): ABIGAIL MEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 14TH ST
SANTA MONICA CA
90404-4605
US

IV. Provider business mailing address

6500 GREEN VALLEY CIR APT 125
CULVER CITY CA
90230-7012
US

V. Phone/Fax

Practice location:
  • Phone: 310-344-2276
  • Fax:
Mailing address:
  • Phone: 612-968-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number305217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: