Healthcare Provider Details

I. General information

NPI: 1245588227
Provider Name (Legal Business Name): MEGAN MCKINNEY WATTS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 SILVERSIDE ROAD SPRINGER BUILDING, SUITE 105
WILMINGTON DE
19810
US

IV. Provider business mailing address

6411 SILVERSIDE ROAD SPRINGER BUILDING, SUITE 105
WILMINGTON DE
19810
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-5240
  • Fax:
Mailing address:
  • Phone: 302-478-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002891
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: