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NPI Code Detail

MEDICARE: MEGAN KOPPENHOEFER MPT

MEDICARE:   MEGAN  KOPPENHOEFER  MPT
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
1225100000XPhysical Therapist070013197IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00846570OTHERILMEDICARE RAILROAD
2P00931574OTHERILMEDICARE RAILROAD

General Provider Information

NPI Number : 1619011467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN KOPPENHOEFER MPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number :
Provider Business Practice Location Address
First Line : 1226 S CANAL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-5213
Country : US
Telephone Number : 312-733-8958
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 07/19/2011

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Directions to “ MEGAN KOPPENHOEFER MPT” Practice Location

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