Provider Demographics
NPI:1790900959
Name:PERHACH, MEGAN NICOLE (DPT, PT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE
Last Name:PERHACH
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:NICOLE
Other - Last Name:HEINRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:805 AEROVISTA PL
Mailing Address - Street 2:201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7919
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:1345 PARK ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2236
Practice Address - Country:US
Practice Address - Phone:805-226-0975
Practice Address - Fax:805-226-0909
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABG240ZMedicare PIN