Provider Demographics
NPI:1295043164
Name:BOULANGER, MEGAN WENDER (PT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:WENDER
Last Name:BOULANGER
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 1:22401 E POWERS PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6505
Mailing Address - Country:US
Mailing Address - Phone:832-545-3316
Mailing Address - Fax:
Practice Address - Street 1:22401 E POWERS PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6505
Practice Address - Country:US
Practice Address - Phone:832-545-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist