Healthcare Provider Details

I. General information

NPI: 1194380394
Provider Name (Legal Business Name): MEGAN E MILLSAP DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN E ROBERT DPT

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 LAKEWOOD DR W
TACOMA WA
98467-3331
US

IV. Provider business mailing address

6419 LAKEWOOD DR W
TACOMA WA
98467-3331
US

V. Phone/Fax

Practice location:
  • Phone: 532-531-8873
  • Fax:
Mailing address:
  • Phone: 541-844-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4456
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62289
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number60965278
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: