1790900959 NPI number — MRS. MEGAN NICOLE PERHACH DPT, PT

Table of content: MRS. MEGAN NICOLE PERHACH DPT, PT (NPI 1790900959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790900959 NPI number — MRS. MEGAN NICOLE PERHACH DPT, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERHACH
Provider First Name:
MEGAN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT, PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEINRICH
Provider Other First Name:
MEGAN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT, PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790900959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 AEROVISTA PL
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-7919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-788-0805
Provider Business Mailing Address Fax Number:
805-788-0845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1345 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASO ROBLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93446-2236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-226-0975
Provider Business Practice Location Address Fax Number:
805-226-0909
Provider Enumeration Date:
04/14/2007

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:  PT29951 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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