Provider Demographics
NPI:1134950793
Name:SHULTS, MEGAN BROOKE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BROOKE
Last Name:SHULTS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5029
Mailing Address - Country:US
Mailing Address - Phone:865-908-3261
Mailing Address - Fax:865-908-1976
Practice Address - Street 1:2537 SAND PIKE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6272
Practice Address - Country:US
Practice Address - Phone:865-908-3205
Practice Address - Fax:865-908-6238
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist