MEDICARE: DR. MEAGAN WAMPLER DPT

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	2305214364	VA
2	225100000X	Physical Therapist	05015491A	IN

General Provider Information

NPI Number	:	1487221636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEAGAN WAMPLER DPT

Provider Business Mailing Address
First Line	:	5139 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1752
Country	:	US
Telephone Number	:	219-707-6747
Fax Number	:

Provider Business Practice Location Address
First Line	:	5139 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1752
Country	:	US
Telephone Number	:	260-407-9199
Fax Number	:

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/10/2024

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