Healthcare Provider Details

I. General information

NPI: 1700140647
Provider Name (Legal Business Name): MEGAN MARIE DONHAM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E TREMONT ST
HILLSBORO IL
62049-1912
US

IV. Provider business mailing address

1200 E TREMONT ST
HILLSBORO IL
62049-1912
US

V. Phone/Fax

Practice location:
  • Phone: 217-532-4160
  • Fax: 217-532-4166
Mailing address:
  • Phone: 217-532-4160
  • Fax: 217-532-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.018981
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: