Provider Demographics
NPI:1245825330
Name:AQUINO, MEGAN JULYNE DEJESA (PT)
Entity type:Individual
Prefix:
First Name:MEGAN JULYNE
Middle Name:DEJESA
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2541
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-2541
Mailing Address - Country:US
Mailing Address - Phone:671-486-7484
Mailing Address - Fax:
Practice Address - Street 1:224 FARENHOLT AVE
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3224
Practice Address - Country:US
Practice Address - Phone:671-647-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214119225100000X
GUPT-159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist