=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801262613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA MEGONIGAL LPTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2015
-----------------------------------------------------
Last Update Date | 08/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 JEFFERSON AVE
-----------------------------------------------------
City | CHARLES TOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25414-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-408-6697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 JEFFERSON AVE
-----------------------------------------------------
City | CHARLES TOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25414-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-408-6697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2306604260
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------