Provider Demographics
NPI:1407840663
Name:CHRISTENSON, MEAGAN JO (ATC)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:JO
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26026 240TH ST
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:MN
Mailing Address - Zip Code:56590-9706
Mailing Address - Country:US
Mailing Address - Phone:320-808-4955
Mailing Address - Fax:
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3703
Practice Address - Country:US
Practice Address - Phone:320-762-6079
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer