MEDICARE: DR. MEGAN DANZL PT, PHD, NCS

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	2251N0400X	Neurology Physical Therapist	4904	KY
2	2251N0400X	Neurology Physical Therapist	05008894A	IN

General Provider Information

NPI Number	:	1902230303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN DANZL PT, PHD, NCS

Provider Business Mailing Address
First Line	:	2001 NEWBURG RD # ALLEN368
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1863
Country	:	US
Telephone Number	:	502-272-7368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 NEWBURG RD # ALLEN368
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1863
Country	:	US
Telephone Number	:	502-272-7368
Fax Number	:

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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