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General NPI Number Information
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NPI Number | 1851715148
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Entity Type | Individual
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Provider Name | MEGAN TEACHWORTH PTA
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Gender | Female
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 512 BEACH ST
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City | FENTON
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State | MI
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Zip | 48430-3122
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Country | US
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Telephone | 810-629-4117
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Fax |
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Provider Business Mailing Address
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Address Line | 2163 AMY ST
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City | BURTON
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State | MI
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Zip | 48519-1107
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Country | US
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Telephone | 810-965-4787
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502001662
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License Number State | MI
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