Provider Demographics
NPI:1750329389
Name:POCKRUS, MEGAN M (MPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:POCKRUS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 WHITESBURG DR S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1632
Mailing Address - Country:US
Mailing Address - Phone:256-881-5151
Mailing Address - Fax:256-880-3939
Practice Address - Street 1:4769 WHITESBURG DR S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1632
Practice Address - Country:US
Practice Address - Phone:256-319-8500
Practice Address - Fax:256-319-8503
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist