Provider Demographics
NPI:1831523521
Name:HASBUN, MEAGAN DENISE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:DENISE
Last Name:HASBUN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N STATE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-4900
Mailing Address - Country:US
Mailing Address - Phone:208-428-6079
Mailing Address - Fax:208-209-6079
Practice Address - Street 1:650 N STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-4900
Practice Address - Country:US
Practice Address - Phone:208-428-6079
Practice Address - Fax:208-209-6079
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041660-1225100000X
NCP21111225100000X
ID81610782251P0200X
WAPT60401857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0316221OtherDEPT. OF LABOR AND INDUSTRIES
WA1831523521Medicaid
WAG8923924Medicare PIN