Provider Demographics
NPI:1851893622
Name:PENDERGRAFT, MEGAN LEIGH (ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:PENDERGRAFT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 CANONERO PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7106
Mailing Address - Country:US
Mailing Address - Phone:919-880-8939
Mailing Address - Fax:
Practice Address - Street 1:11800 CANONERO PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-7106
Practice Address - Country:US
Practice Address - Phone:919-880-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer