Provider Demographics
NPI:1184012908
Name:KLINE, MEGAN (PTA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 FARAON ST
Mailing Address - Street 2:APT O6
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3479
Mailing Address - Country:US
Mailing Address - Phone:712-540-4806
Mailing Address - Fax:
Practice Address - Street 1:5050 FARAON ST
Practice Address - Street 2:APT O6
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3479
Practice Address - Country:US
Practice Address - Phone:712-540-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02470225200000X
MO2013006327225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant