Provider Demographics
NPI:1609127380
Name:RAPHAEL, MEGAN C (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2828 S MCCALL RD STE 25
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-9517
Mailing Address - Country:US
Mailing Address - Phone:941-474-2700
Mailing Address - Fax:
Practice Address - Street 1:1104 S CLARKE RD STE 30
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6878
Practice Address - Country:US
Practice Address - Phone:407-401-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist