Provider Demographics
NPI:1225212327
Name:MEGCHELSEN, PATRICIA C (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:C
Last Name:MEGCHELSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 S MAIN ST
Mailing Address - Street 2:SUITES A B
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5031
Mailing Address - Country:US
Mailing Address - Phone:630-466-5866
Mailing Address - Fax:630-466-5869
Practice Address - Street 1:38 S MAIN ST
Practice Address - Street 2:SUITES A B
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5031
Practice Address - Country:US
Practice Address - Phone:630-466-5866
Practice Address - Fax:630-466-5869
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-4395802OtherTAX ID NUMBER