Provider Demographics
NPI:1417030255
Name:HERREN, MEGAN R (MPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:HERREN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5799 BROADMOOR STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISSION
Mailing Address - State:KY
Mailing Address - Zip Code:66202
Mailing Address - Country:US
Mailing Address - Phone:913-384-5600
Mailing Address - Fax:913-384-0719
Practice Address - Street 1:8516 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2433
Practice Address - Country:US
Practice Address - Phone:816-436-4500
Practice Address - Fax:816-436-4510
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005012173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist