Provider Demographics
NPI:1811400278
Name:WARDEN, MEAGAN JEAN (PTA, LMT)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:JEAN
Last Name:WARDEN
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:MS
Other - First Name:MEAGAN
Other - Middle Name:JEAN
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:740 W GRAND RIVER
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116
Mailing Address - Country:US
Mailing Address - Phone:810-227-3588
Mailing Address - Fax:810-626-4045
Practice Address - Street 1:740 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2392
Practice Address - Country:US
Practice Address - Phone:810-227-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000683225700000X
MI5502004372225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist