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General NPI Number Information
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NPI Number | 1942640925
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Entity Type | Individual
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Provider Name | MEGAN N. DIVINE PT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 7600 SANDY ROCK PT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-5222
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Country | US
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Telephone | 503-744-5406
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Fax |
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Provider Business Mailing Address
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Address Line | 25117 SW PARKWAY AVE STE D
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City | WILSONVILLE
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State | OR
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Zip | 97070-9697
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Country | US
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Telephone | 503-744-5406
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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 | 12142-24
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PTL.0013053
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License Number State | CO
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