Provider Demographics
NPI:1679093819
Name:CHRISTOFFEL, MEGAN (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CHRISTOFFEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1397
Mailing Address - Country:US
Mailing Address - Phone:614-839-2115
Mailing Address - Fax:614-523-7557
Practice Address - Street 1:70 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1397
Practice Address - Country:US
Practice Address - Phone:614-839-2115
Practice Address - Fax:614-523-7557
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT016874225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant