Provider Demographics
NPI:1447430103
Name:LAUSEN, MEGAN T (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:T
Last Name:LAUSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:T
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1350 CENTRAL AVE
Mailing Address - Street 2:P.T. PLUS
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544
Mailing Address - Country:US
Mailing Address - Phone:505-662-3384
Mailing Address - Fax:505-661-0085
Practice Address - Street 1:1350 CENTRAL AVE
Practice Address - Street 2:P.T. PLUS
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544
Practice Address - Country:US
Practice Address - Phone:505-662-3384
Practice Address - Fax:505-661-0085
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011489225100000X
NM3880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00467239OtherRAILROAD MEDICARE
ILK47763Medicare PIN