Provider Demographics
NPI:1467738047
Name:MEGILL, MARC JOHN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:JOHN
Last Name:MEGILL
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6982 SHOREVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6847
Mailing Address - Country:US
Mailing Address - Phone:469-272-2000
Mailing Address - Fax:469-272-3393
Practice Address - Street 1:1 LONGHORN BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2748
Practice Address - Country:US
Practice Address - Phone:469-272-2000
Practice Address - Fax:469-272-3393
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer