Provider Demographics
NPI:1174015663
Name:BOSMA, MEGAN CHRISTINE (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CHRISTINE
Last Name:BOSMA
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S OHLMAN ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-3109
Mailing Address - Country:US
Mailing Address - Phone:605-996-7701
Mailing Address - Fax:605-995-6134
Practice Address - Street 1:500 S OHLMAN ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-3109
Practice Address - Country:US
Practice Address - Phone:605-996-7701
Practice Address - Fax:605-995-6134
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist