Provider Demographics
NPI:1407205644
Name:CLIFTON, MEGAN
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:6947 BOOMERSHINE RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-8516
Mailing Address - Country:US
Mailing Address - Phone:937-689-7989
Mailing Address - Fax:
Practice Address - Street 1:300 ASTORIA RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1712
Practice Address - Country:US
Practice Address - Phone:937-855-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1346513090Medicaid