Provider Demographics
NPI:1407048986
Name:KORTEMEYER, MEGAN JAYE (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JAYE
Last Name:KORTEMEYER
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 1:4512 S GALWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-7628
Mailing Address - Country:US
Mailing Address - Phone:605-212-4280
Mailing Address - Fax:
Practice Address - Street 1:4512 S GALWAY AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-7628
Practice Address - Country:US
Practice Address - Phone:605-212-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist