Provider Demographics
NPI:1700367745
Name:WHITE, MEGAN C (MS, LAT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15222 FAIRCREST DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STA
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7179
Mailing Address - Country:US
Mailing Address - Phone:806-789-8298
Mailing Address - Fax:
Practice Address - Street 1:15222 FAIRCREST DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STA
Practice Address - State:TX
Practice Address - Zip Code:77845-7179
Practice Address - Country:US
Practice Address - Phone:180-678-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT71332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer