Provider Demographics
NPI:1801487772
Name:VANSCOYOC, MEGAN ROSE (PTA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:VANSCOYOC
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ROSE
Other - Last Name:RADUNZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 3675
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-3675
Mailing Address - Country:US
Mailing Address - Phone:405-214-0300
Mailing Address - Fax:
Practice Address - Street 1:503 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-2017
Practice Address - Country:US
Practice Address - Phone:405-598-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2794225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant