Healthcare Provider Details

I. General information

NPI: 1821238015
Provider Name (Legal Business Name): MEGAN ANN IRVING PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 165TH ST
ALBIA IA
52531-8793
US

IV. Provider business mailing address

23616 430TH ST
MORAVIA IA
52571-8905
US

V. Phone/Fax

Practice location:
  • Phone: 800-334-1919
  • Fax: 402-334-6844
Mailing address:
  • Phone: 641-895-2771
  • Fax: 641-932-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00753
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: