Provider Demographics
NPI:1114318904
Name:MUNDT, MEGAN (PTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MUNDT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3131 S 46TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-3737
Mailing Address - Country:US
Mailing Address - Phone:913-669-5498
Mailing Address - Fax:
Practice Address - Street 1:3131 S 46TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-3737
Practice Address - Country:US
Practice Address - Phone:913-669-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02209225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant