Provider Demographics
NPI:1467768895
Name:TIBALDI, MEGAN KELLY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:KELLY
Last Name:TIBALDI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:KELLY
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1072 OLDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4683
Mailing Address - Country:US
Mailing Address - Phone:610-737-4142
Mailing Address - Fax:
Practice Address - Street 1:1072 OLDSTONE RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4683
Practice Address - Country:US
Practice Address - Phone:610-737-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT001874225100000X
PAPT018193225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist