=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528515244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN PACETTI ATC, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2016
-----------------------------------------------------
Last Update Date | 01/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3010 W LOOP 1604 N APT 6305
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-837-9721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 W LOOP 1604 N APT 6305
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-837-9721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT8431
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------