Provider Demographics
NPI:1356905491
Name:BALCOM, MEGAN (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BALCOM
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-4030
Mailing Address - Country:US
Mailing Address - Phone:785-239-3627
Mailing Address - Fax:
Practice Address - Street 1:1554 LYMAN RD
Practice Address - Street 2:BLDG 3004
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:KS
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-787-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013088225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist