Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1437540069 | OH |
NPI | 1174084859 |
---|---|
Provider Name | Megan Michelle Pack |
First Address | Lewis Center, OH 43035-8619 |
Second Address | Lewis Center, OH 43035-8619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2019 |
Last Update Date | 11/06/2019 |