Provider Demographics
NPI:1356944862
Name:GIAMBASTINI, MEGAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GIAMBASTINI
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 1:380 CIVIC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1946
Mailing Address - Country:US
Mailing Address - Phone:925-284-3840
Mailing Address - Fax:855-814-5469
Practice Address - Street 1:380 CIVIC DR STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1946
Practice Address - Country:US
Practice Address - Phone:925-284-3840
Practice Address - Fax:855-814-5469
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT299543OtherPT BOARD