Provider Demographics
NPI:1700140647
Name:DONHAM, MEGAN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:DONHAM
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 1:1200 E TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1912
Mailing Address - Country:US
Mailing Address - Phone:217-532-4160
Mailing Address - Fax:217-532-4166
Practice Address - Street 1:1200 E TREMONT ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1912
Practice Address - Country:US
Practice Address - Phone:217-532-4160
Practice Address - Fax:217-532-4166
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist