Provider Demographics
NPI:1619110111
Name:WOHLLEBEN, MEGAN SUE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUE
Last Name:WOHLLEBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30133 E SCOUTEN LOOP RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8695
Mailing Address - Country:US
Mailing Address - Phone:360-770-4762
Mailing Address - Fax:
Practice Address - Street 1:30133 E SCOUTEN LOOP RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8695
Practice Address - Country:US
Practice Address - Phone:360-770-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant