Provider Demographics
NPI:1932885399
Name:WARDYN, MEGAN JENAE (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JENAE
Last Name:WARDYN
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 1:3011 SOTHMAN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7262
Mailing Address - Country:US
Mailing Address - Phone:308-380-3052
Mailing Address - Fax:
Practice Address - Street 1:3582 BLUE HORIZON VW STE 156
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-4608
Practice Address - Country:US
Practice Address - Phone:719-344-9497
Practice Address - Fax:719-358-6042
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NE44992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic