Provider Demographics
NPI:1497911226
Name:LONGENECKER, MEGAN NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:LONGENECKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 GRAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6546
Mailing Address - Country:US
Mailing Address - Phone:406-655-9060
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:3307 GRAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6546
Practice Address - Country:US
Practice Address - Phone:406-655-9060
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2135PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist