Provider Demographics
NPI:1568745917
Name:MEGA, LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:MEGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:HELENA
Other - Last Name:MEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:86 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2434
Mailing Address - Country:US
Mailing Address - Phone:860-444-8713
Mailing Address - Fax:860-444-8713
Practice Address - Street 1:86 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2434
Practice Address - Country:US
Practice Address - Phone:860-444-8713
Practice Address - Fax:860-444-8713
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030051-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist