Provider Demographics
NPI:1851715148
Name:TEACHWORTH, MEGAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:TEACHWORTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2163 AMY ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1107
Mailing Address - Country:US
Mailing Address - Phone:810-965-4787
Mailing Address - Fax:
Practice Address - Street 1:512 BEACH ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3122
Practice Address - Country:US
Practice Address - Phone:810-629-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001662225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant