Healthcare Provider Details

I. General information

NPI: 1548933112
Provider Name (Legal Business Name): MEGAN MALY LAT, ATC, MATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HUDSON ROAD
CEDAR FALLS IA
50613-5061
US

IV. Provider business mailing address

2301 HUDSON ROAD
CEDAR FALLS IA
50613
US

V. Phone/Fax

Practice location:
  • Phone: 319-273-6275
  • Fax:
Mailing address:
  • Phone: 319-273-6275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number120867
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: