MEDICARE: MEGAN FASANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT027866	PA

General Provider Information

NPI Number	:	1205411303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN FASANO

Provider Business Mailing Address
First Line	:	1926 SOUTH ST UNIT A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1434
Country	:	US
Telephone Number	:	215-353-1895
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 DALY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-3247
Country	:	US
Telephone Number	:	215-353-1895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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Directions to “ MEGAN FASANO ” Practice Location

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