Individual
MRS. MEGAN ELLEN ANTALIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2770 S ADAMS ST, BLOOMINGTON, IN 47403-3242
(812) 323-4661
Mailing address
3129 S RYAN PL, BLOOMINGTON, IN 47403-4378
(419) 234-7093
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005218A
IN
Other
Enumeration date
11/23/2015
Last updated
11/23/2015
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