Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 14-01515 | KS |
NPI | 1003014945 |
---|---|
Provider Name | Mrs. Megan Rochelle Burge |
First Address | Olathe, KS 66061-3854 |
Second Address | Overland Park, KS 66214-2658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 13/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14-01515 | STATE LICENSE (01) | KS |
2002019267 | STATE LICENSE (01) | MO |