Provider Demographics
NPI:1750652046
Name:BLEEM, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BLEEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1016
Mailing Address - Country:US
Mailing Address - Phone:618-317-6093
Mailing Address - Fax:
Practice Address - Street 1:13138 ILLINOIS 13
Practice Address - Street 2:
Practice Address - City:COULTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62237
Practice Address - Country:US
Practice Address - Phone:618-758-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant