Provider Demographics
NPI:1669973418
Name:SOBOLIC, MEGAN MARIE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:SOBOLIC
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5570 PEBBLE VILLAGE LN STE 300
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7409
Mailing Address - Country:US
Mailing Address - Phone:317-678-9861
Mailing Address - Fax:317-678-9862
Practice Address - Street 1:5570 PEBBLE VILLAGE LN STE 300
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7409
Practice Address - Country:US
Practice Address - Phone:317-678-9861
Practice Address - Fax:317-678-9862
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017572225100000X
IN05015155A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist