Provider Demographics
NPI:1588663116
Name:GRANDONE, MEGAN E (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:E
Last Name:GRANDONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:SCHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5387
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-5387
Mailing Address - Country:US
Mailing Address - Phone:309-661-8823
Mailing Address - Fax:309-661-8801
Practice Address - Street 1:1201 E BROADWAY STE C
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1995
Practice Address - Country:US
Practice Address - Phone:309-734-1103
Practice Address - Fax:309-734-2013
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146672Medicare ID - Type Unspecified