Provider Demographics
NPI:1801262613
Name:MEGONIGAL, MONICA (LPTA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MEGONIGAL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-1122
Mailing Address - Country:US
Mailing Address - Phone:703-408-6697
Mailing Address - Fax:
Practice Address - Street 1:160 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1122
Practice Address - Country:US
Practice Address - Phone:703-408-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-16
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604260225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant