Provider Demographics
NPI:1639636095
Name:WESLEY, MEGAN (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WESLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 CHUKKA HINA
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7117
Mailing Address - Country:US
Mailing Address - Phone:580-920-2100
Mailing Address - Fax:
Practice Address - Street 1:1802 CHUKKA HINA
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7117
Practice Address - Country:US
Practice Address - Phone:580-920-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5593208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation