Provider Demographics
NPI:1558994830
Name:GIBBONS, MEGAN NORA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NORA
Last Name:GIBBONS
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 1:13119 SEATTLE HILL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-3402
Mailing Address - Country:US
Mailing Address - Phone:425-954-2696
Mailing Address - Fax:
Practice Address - Street 1:13119 SEATTLE HILL RD
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-3400
Practice Address - Country:US
Practice Address - Phone:425-954-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298109208100000X, 225100000X
WAPT61211714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation