Provider Demographics
NPI:1235777459
Name:SANTOS, MEGAN L (ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:SANTOS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DRY MILL RD SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3409
Mailing Address - Country:US
Mailing Address - Phone:571-252-2010
Mailing Address - Fax:
Practice Address - Street 1:415 DRY MILL RD SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3409
Practice Address - Country:US
Practice Address - Phone:571-252-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260015402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126001540OtherCOMMONWEALTH OF VIRGINIA BOARD OF MEDICINE LICENSE
060802096OtherNATA BOC