Healthcare Provider Details

I. General information

NPI: 1619640885
Provider Name (Legal Business Name): MEGAN WENGER MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 1ST AVE NE
CEDAR RAPIDS IA
52402-5008
US

IV. Provider business mailing address

2802 SHAMAN AVE SW
CEDAR RAPIDS IA
52404-4883
US

V. Phone/Fax

Practice location:
  • Phone: 319-533-3950
  • Fax:
Mailing address:
  • Phone: 319-533-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number092086
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: