Provider Demographics
NPI:1982036547
Name:VINCENT, MEGAN ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2812
Mailing Address - Country:US
Mailing Address - Phone:304-599-2512
Mailing Address - Fax:304-285-3738
Practice Address - Street 1:1228 COUNTRY CLUB RD
Practice Address - Street 2:#15
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2369
Practice Address - Country:US
Practice Address - Phone:304-366-0461
Practice Address - Fax:304-366-0497
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT 003213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist