Healthcare Provider Details

I. General information

NPI: 1396055372
Provider Name (Legal Business Name): MEGAN MANS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 KANSAS ST.
DOWNS KS
67437
US

IV. Provider business mailing address

1218 KANSAS ST
DOWNS KS
67437
US

V. Phone/Fax

Practice location:
  • Phone: 785-454-3378
  • Fax: 785-454-3403
Mailing address:
  • Phone: 785-454-3321
  • Fax: 785-454-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberT-02823
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02194
License Number StateKS

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: