Healthcare Provider Details

I. General information

NPI: 1568854586
Provider Name (Legal Business Name): MEGAN ANNE GEBERT MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN ANNE THOMPSON MS, ATC

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CROSS RD
MARLBORO NY
12542-6009
US

IV. Provider business mailing address

13 2ND ST
CORNWALL ON HUDSON NY
12520-1312
US

V. Phone/Fax

Practice location:
  • Phone: 845-236-8000
  • Fax:
Mailing address:
  • Phone: 845-926-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number7157184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: