Provider Demographics
NPI:1508985367
Name:WITZGALL, MEGAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:WITZGALL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WASHINGTON AVE
Mailing Address - Street 2:PT DEPARTMENT
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 WASHINGTON AVE
Practice Address - Street 2:PT DEPARTMENT
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6243
Practice Address - Country:US
Practice Address - Phone:304-243-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01215400225100000X
NY030116-1225100000X
WV0024642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001372Medicaid