Provider Demographics
NPI:1740764141
Name:MATHIEU, MEGAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MALLGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:820 CARP RIVER LN STE 2
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-3187
Mailing Address - Country:US
Mailing Address - Phone:906-204-7400
Mailing Address - Fax:
Practice Address - Street 1:820 CARP RIVER LN STE 2
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3187
Practice Address - Country:US
Practice Address - Phone:906-204-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist