Healthcare Provider Details

I. General information

NPI: 1265467427
Provider Name (Legal Business Name): MEAGAN JANE BARNETTE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 21ST AVE STE 3
CHIEFLAND FL
32626-1959
US

IV. Provider business mailing address

140 ILLINOIS DR
JACKSONVILLE AR
72076-1014
US

V. Phone/Fax

Practice location:
  • Phone: 352-493-2999
  • Fax: 352-493-0026
Mailing address:
  • Phone: 334-477-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 20464
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 2481
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: