Provider Demographics
NPI:1346640943
Name:SCULLY, MEGAN (PTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SCULLY
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 1:200 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3326
Mailing Address - Country:US
Mailing Address - Phone:973-887-8080
Mailing Address - Fax:973-386-5974
Practice Address - Street 1:200 REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3326
Practice Address - Country:US
Practice Address - Phone:973-887-8080
Practice Address - Fax:973-386-5974
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00309600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant