Provider Demographics
NPI:1609191626
Name:PHILLIPS, MEGAN ANN (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:DARDZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 11629
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59719-1629
Mailing Address - Country:US
Mailing Address - Phone:406-522-7488
Mailing Address - Fax:406-522-7487
Practice Address - Street 1:312 W. MAIN ST.
Practice Address - Street 2:SUITE #1
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3836
Practice Address - Country:US
Practice Address - Phone:406-388-2235
Practice Address - Fax:406-388-2281
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36517225100000X
MT13110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist