Provider Demographics
NPI:1407178361
Name:DAGLE, MEGAN ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:DAGLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CAROLINE RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4611
Mailing Address - Country:US
Mailing Address - Phone:406-407-2077
Mailing Address - Fax:844-777-1836
Practice Address - Street 1:227 CAROLINE RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4611
Practice Address - Country:US
Practice Address - Phone:406-407-2077
Practice Address - Fax:844-777-1836
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500618769Medicaid
OR1407178361Medicaid
ORP00877708OtherRR MEDICARE
ORR152738Medicare PIN