Provider Demographics
NPI:1528374527
Name:VANDEN BERG, MEGAN (PT, MPT, PCS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VANDEN BERG
Suffix:
Gender:F
Credentials:PT, MPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636B HOLLY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-9487
Mailing Address - Country:US
Mailing Address - Phone:919-207-1715
Mailing Address - Fax:
Practice Address - Street 1:3636B HOLLY GROVE RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-9487
Practice Address - Country:US
Practice Address - Phone:919-207-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44122251P0200X
NCP136192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics