Provider Demographics
NPI:1407890312
Name:STANKOWSKI, MEGAN LORENE (PT, LAT)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:LORENE
Last Name:STANKOWSKI
Suffix:
Gender:F
Credentials:PT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WESTHILLL DR
Mailing Address - Street 2:# 100
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-847-2827
Mailing Address - Fax:715-847-2948
Practice Address - Street 1:3200 WESTHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4706
Practice Address - Country:US
Practice Address - Phone:715-847-2827
Practice Address - Fax:715-847-2048
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11231-24225100000X
WI7760392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer