Provider Demographics
NPI:1528399466
Name:TONEY, MEGAN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:TONEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 KERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-2214
Mailing Address - Country:US
Mailing Address - Phone:618-724-9604
Mailing Address - Fax:
Practice Address - Street 1:505 KERRY DR
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822-2214
Practice Address - Country:US
Practice Address - Phone:618-724-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004526225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant