Individual
MEGAN IVANOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
208 S MAIN ST, MOSCOW, PA 18444-9135
(570) 842-9323
(570) 842-9362
Mailing address
208 S MAIN ST, MOSCOW, PA 18444-9135
(570) 842-9323
(570) 842-9362
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT023648
PA
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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