Healthcare Provider Details

I. General information

NPI: 1386230381
Provider Name (Legal Business Name): MEGAN MCCOLLUM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58A W STAFFORD RD
STAFFORD SPRINGS CT
06076-1067
US

IV. Provider business mailing address

435 HARTFORD TPKE STE U
VERNON ROCKVILLE CT
06066-4834
US

V. Phone/Fax

Practice location:
  • Phone: 860-684-6528
  • Fax:
Mailing address:
  • Phone: 860-870-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012813
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: