Provider Demographics
NPI:1710180286
Name:THIEDEMAN, MEGAN LYNN (MSS)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:LYNN
Last Name:THIEDEMAN
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 GRAYSON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1836
Mailing Address - Country:US
Mailing Address - Phone:210-478-5332
Mailing Address - Fax:210-478-5384
Practice Address - Street 1:9502 HUEBNER ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-478-5332
Practice Address - Fax:210-478-5384
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer