Provider Demographics
NPI:1164129987
Name:BABCOCK, MEGAN ELISE (PTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7566 TURTLE TRL
Mailing Address - Street 2:
Mailing Address - City:PARDEEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53954-9713
Mailing Address - Country:US
Mailing Address - Phone:608-408-0176
Mailing Address - Fax:
Practice Address - Street 1:307 ROYALL AVE
Practice Address - Street 2:
Practice Address - City:ELROY
Practice Address - State:WI
Practice Address - Zip Code:53929-1044
Practice Address - Country:US
Practice Address - Phone:608-462-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2479-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant