Healthcare Provider Details

I. General information

NPI: 1902230303
Provider Name (Legal Business Name): MEGAN DANZL PT, PHD, NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 NEWBURG RD # ALLEN368
LOUISVILLE KY
40205-1863
US

IV. Provider business mailing address

2001 NEWBURG RD # ALLEN368
LOUISVILLE KY
40205-1863
US

V. Phone/Fax

Practice location:
  • Phone: 502-272-7368
  • Fax:
Mailing address:
  • Phone: 502-272-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number4904
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number05008894A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: