Provider Demographics
NPI:1740421007
Name:GLEASON, MEGAN ELIZABETH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SW RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9481
Mailing Address - Country:US
Mailing Address - Phone:541-548-5066
Mailing Address - Fax:541-548-8302
Practice Address - Street 1:3025 SW RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9481
Practice Address - Country:US
Practice Address - Phone:541-548-5066
Practice Address - Fax:541-548-8302
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR51802251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics