Provider Demographics
NPI:1659835064
Name:LIMBERG, MEGAN KERRY
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KERRY
Last Name:LIMBERG
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 1:1208 WALNUT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4258
Mailing Address - Country:US
Mailing Address - Phone:970-819-4457
Mailing Address - Fax:
Practice Address - Street 1:1208 WALNUT AVE APT 1
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4258
Practice Address - Country:US
Practice Address - Phone:970-819-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
COALM0109505OtherAXIS