=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851772263
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN GRAVER DPT, OCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2015
-----------------------------------------------------
Last Update Date | 03/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2684 HIBBERT AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43202-2447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-699-3868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2684 HIBBERT AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43202-2447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-699-3868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 016489
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------