Individual
MEGAN E WACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1295 WESTHAVEN DR, VAIL, CO 81657-4395
(970) 476-7510
(970) 476-7511
Mailing address
PO BOX 1311, VAIL, CO 81658-1311
(970) 476-7510
(970) 476-7511
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8955
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO8955
STATE LICENSE
CO
Enumeration date
09/22/2008
Last updated
03/26/2009
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