Provider Demographics
NPI:1235181173
Name:O'MAHONY, MEGAN (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:O'MAHONY
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 1:13537 BARRETT PARKWAY DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5806
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:14825 N OUTER FORTY RD.
Practice Address - Street 2:STE 300
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-0002
Practice Address - Country:US
Practice Address - Phone:636-812-1211
Practice Address - Fax:636-812-0159
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO221981511Medicare ID - Type UnspecifiedOUT OF AREA
MO221981509Medicare ID - Type UnspecifiedIN AREA