Healthcare Provider Details

I. General information

NPI: 1558225995
Provider Name (Legal Business Name): MEGAN PHAM PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 NE MARSHALL AVE
BEND OR
97701-4346
US

IV. Provider business mailing address

330 NE MARSHALL AVE
BEND OR
97701-4346
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-8179
  • Fax: 541-685-2639
Mailing address:
  • Phone: 541-383-8179
  • Fax: 541-685-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65873
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: