Provider Demographics
NPI:1275807984
Name:OLIVER, MEGGAN (PT)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:
Last Name:OLIVER
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:PO BOX 2686
Mailing Address - Street 2:311 5TH STREET
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-2686
Mailing Address - Country:US
Mailing Address - Phone:970-251-5098
Mailing Address - Fax:970-251-5090
Practice Address - Street 1:140 BLACKSTOCK DR UNIT A
Practice Address - Street 2:311 5TH STREET
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-8001
Practice Address - Country:US
Practice Address - Phone:970-251-5098
Practice Address - Fax:970-251-5090
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO524172OtherMEDICARE PTAN
CO12349513OtherCAQH