Healthcare Provider Details

I. General information

NPI: 1427509793
Provider Name (Legal Business Name): MEGAN WYLIE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 JOHN YOUNG WAY SUITE 200
EXTON PA
19341
US

IV. Provider business mailing address

470 JOHN YOUNG WAY SUITE 200
EXTON PA
19341
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-3076
  • Fax: 610-873-3078
Mailing address:
  • Phone: 610-873-3076
  • Fax: 610-873-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01694000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT025310
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: