Provider Demographics
NPI:1831450410
Name:TENNANT, MEGAN ANNE (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANNE
Last Name:TENNANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2101 STONE BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4044
Mailing Address - Country:US
Mailing Address - Phone:916-617-2400
Mailing Address - Fax:916-617-2403
Practice Address - Street 1:2101 STONE BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4044
Practice Address - Country:US
Practice Address - Phone:916-617-2400
Practice Address - Fax:916-617-2403
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist