Healthcare Provider Details

I. General information

NPI: 1285151571
Provider Name (Legal Business Name): MEGAN FERGUSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN PHILIPP

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 OAKS XING
PLAINWELL MI
49080-1916
US

IV. Provider business mailing address

6016 LOVERS LN STE 3
PORTAGE MI
49002-3050
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-9640
  • Fax: 269-685-9641
Mailing address:
  • Phone: 615-591-6590
  • Fax: 615-591-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11302
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018521
License Number StateMI

VII. Legacy identifiers

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

# 1
Identifier0446631
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: