Provider Demographics
NPI:1821478413
Name:GRACE, MEAGAN SIOBHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:SIOBHAN
Last Name:GRACE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:SIOBHAN
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3627 SE 29TH ST
Practice Address - Street 2:STE 107
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2013
Practice Address - Country:US
Practice Address - Phone:785-266-4600
Practice Address - Fax:785-266-4601
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist