Provider Demographics
NPI:1417308776
Name:BOND, MEGAN EMILY (LMT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILY
Last Name:BOND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-8713
Mailing Address - Country:US
Mailing Address - Phone:478-308-3466
Mailing Address - Fax:
Practice Address - Street 1:1253 MACEDONIA CHURCH RD
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-4565
Practice Address - Country:US
Practice Address - Phone:478-308-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009277225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist