Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1548735376 |
---|---|
Provider Name | Megan Lowe |
First Address | Wethersfield, CT 06109-3930 |
Second Address | Wethersfield, CT 06109-3930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2018 |
Last Update Date | 08/10/2018 |