Provider Demographics
NPI:1144608076
Name:BACKUS, MEGAN RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:BACKUS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 7TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5916
Mailing Address - Country:US
Mailing Address - Phone:917-805-0991
Mailing Address - Fax:
Practice Address - Street 1:208 E 7TH ST APT 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-5916
Practice Address - Country:US
Practice Address - Phone:917-805-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist