Provider Demographics
NPI:1841630480
Name:FAIN, MEGAN (DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FAIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17233 N HOLMES BLVD STE 1650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2031
Mailing Address - Country:US
Mailing Address - Phone:602-547-1836
Mailing Address - Fax:602-547-2806
Practice Address - Street 1:1941 W GUADALUPE RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7483
Practice Address - Country:US
Practice Address - Phone:480-491-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85468622401225100000X
WAPT60717261225100000X
AZLPT-31723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-31723OtherAZ PT BOARD