Healthcare Provider Details

I. General information

NPI: 1184012908
Provider Name (Legal Business Name): MEGAN KLINE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 FARAON ST APT O6
SAINT JOSEPH MO
64506-3479
US

IV. Provider business mailing address

5050 FARAON ST APT O6
SAINT JOSEPH MO
64506-3479
US

V. Phone/Fax

Practice location:
  • Phone: 712-540-4806
  • Fax:
Mailing address:
  • Phone: 712-540-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02470
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2013006327
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: