Provider Demographics
NPI:1700021086
Name:BRODWOLF, MEGAN MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:BRODWOLF
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1880 N. PERRY ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1164
Mailing Address - Country:US
Mailing Address - Phone:419-523-9003
Mailing Address - Fax:419-523-9143
Practice Address - Street 1:333 NORTH STREET
Practice Address - Street 2:STE 102
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-1070
Practice Address - Country:US
Practice Address - Phone:419-692-0095
Practice Address - Fax:419-692-0097
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.0121392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2251343Medicaid
OH366639Medicare Oscar/Certification