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General NPI Number Information
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NPI Number | 1073332581
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Entity Type | Individual
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Provider Name | MEGAN LONG PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 111 HANA HWY STE 107
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City | KAHULUI
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State | HI
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Zip | 96732-2300
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Country | US
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Telephone | 808-877-8717
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Fax | 800-877-8718
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Provider Business Mailing Address
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Address Line | 6723 COOL SPRINGS RD
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City | THOMPSONS STATION
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State | TN
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Zip | 37179-9212
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Country | US
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Telephone | 615-972-2746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-6014-0
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License Number State | HI
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