Provider Demographics
NPI:1073231130
Name:FALLERT, MEGAN JOELLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:JOELLE
Last Name:FALLERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9107 GREYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8470
Mailing Address - Country:US
Mailing Address - Phone:651-341-8522
Mailing Address - Fax:
Practice Address - Street 1:21395 JOHN MILLESS DR STE 600
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4406
Practice Address - Country:US
Practice Address - Phone:763-428-2589
Practice Address - Fax:763-428-4672
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist