Provider Demographics
NPI:1306036462
Name:RESSEL, MEGAN PHYLLIS (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:PHYLLIS
Last Name:RESSEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 AMY DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3651
Mailing Address - Country:US
Mailing Address - Phone:281-837-6370
Mailing Address - Fax:
Practice Address - Street 1:1106 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-5868
Practice Address - Country:US
Practice Address - Phone:281-471-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2062802225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant