Healthcare Provider Details

I. General information

NPI: 1982999041
Provider Name (Legal Business Name): MEGAN DEBLIECK DPT, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N MACARTHUR BLVD SUITE 550
IRVING TX
75061-2219
US

IV. Provider business mailing address

2021 N MACARTHUR BLVD SUITE 550
IRVING TX
75061-2219
US

V. Phone/Fax

Practice location:
  • Phone: 972-579-8155
  • Fax:
Mailing address:
  • Phone: 972-579-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004796
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1229328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: