Provider Demographics
NPI:1518698166
Name:PETERS, MEGAN KELLY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KELLY
Last Name:PETERS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 TRAVIS NORMAN LN
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-7314
Mailing Address - Country:US
Mailing Address - Phone:336-258-0005
Mailing Address - Fax:
Practice Address - Street 1:292 TRAVIS NORMAN LN
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-7314
Practice Address - Country:US
Practice Address - Phone:336-258-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer