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Individual
MRS. MEGAN KATE SMITH
Active
Individual
MRS. MEGAN KATE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006029
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10040251
AMERIGROUP PROVIDER NUM
GA
01
—
322000
WELLCARE POVIDER NUMBER
GA
Enumeration date
11/21/2006
Last updated
07/09/2007
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