Healthcare Provider Details

I. General information

NPI: 1548801491
Provider Name (Legal Business Name): MEGAN FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REQUEST PHYSICAL THERAPY 4820 NEWBERRY ROAD
GAINESVILLE FL
32607-3260
US

IV. Provider business mailing address

2015 NW 26TH ST
GAINESVILLE FL
32605-3857
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-2116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA93099
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: