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NPI Code Detail

MEDICARE: MEGAN BLAYLOCK

MEDICARE: MEGAN BLAYLOCK
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
1225200000XPhysical Therapy Assistant3683NC

General Provider Information

NPI Number : 1548623101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN BLAYLOCK
Provider Business Mailing Address
First Line : 4560 SE INTERNATIONAL WAY STE 100
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-4628
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 SILVER BLUFF DR
Second Line :
City : CANTON
State : NC
Zip : 28716-6350
Country : US
Telephone Number : 828-648-2044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2016
Last Update Date : 03/31/2016

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