Provider Demographics
NPI:1841938610
Name:ALLEN, MEGAN ABIGAIL (PTA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ABIGAIL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4559
Mailing Address - Country:US
Mailing Address - Phone:912-567-6001
Mailing Address - Fax:912-567-6002
Practice Address - Street 1:2806 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4559
Practice Address - Country:US
Practice Address - Phone:912-567-6001
Practice Address - Fax:912-567-6002
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004739225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant