1447430103 NPI number — MRS. MEGAN T LAUSEN P.T.

Table of content: MRS. MEGAN T LAUSEN P.T. (NPI 1447430103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447430103 NPI number — MRS. MEGAN T LAUSEN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUSEN
Provider First Name:
MEGAN
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYLE
Provider Other First Name:
MEGAN
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447430103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 CENTRAL AVE
Provider Second Line Business Mailing Address:
P.T. PLUS
Provider Business Mailing Address City Name:
LOS ALAMOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-662-3384
Provider Business Mailing Address Fax Number:
505-661-0085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 CENTRAL AVE
Provider Second Line Business Practice Location Address:
P.T. PLUS
Provider Business Practice Location Address City Name:
LOS ALAMOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-662-3384
Provider Business Practice Location Address Fax Number:
505-661-0085
Provider Enumeration Date:
11/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070011489 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 3880 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00467239 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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