Healthcare Provider Details

I. General information

NPI: 1295615201
Provider Name (Legal Business Name): MEGAN NICOLE SHEALY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 W BLUEMOUND RD
BROOKFIELD WI
53005-5951
US

IV. Provider business mailing address

5807 N PROSPECT RD
PEORIA IL
61614-4309
US

V. Phone/Fax

Practice location:
  • Phone: 262-207-4680
  • Fax:
Mailing address:
  • Phone: 309-678-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13080
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17658-24
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070029459
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7508
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21074
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: