MEDICARE: MRS. MEGAN CHRISTINE POWERS LAT

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1609513936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN CHRISTINE POWERS LAT

Provider Business Mailing Address
First Line	:	411 N WASHINGTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1713
Country	:	US
Telephone Number	:	214-820-9533
Fax Number	:	717-635-3104

Provider Business Practice Location Address
First Line	:	2948 MISTYS RUN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6833
Country	:	US
Telephone Number	:	817-455-6958
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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