Provider Demographics
NPI:1104080043
Name:MADLOM, MEGAN LYNCH (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNCH
Last Name:MADLOM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RENE
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7402 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7359
Mailing Address - Country:US
Mailing Address - Phone:210-896-0182
Mailing Address - Fax:
Practice Address - Street 1:7402 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7359
Practice Address - Country:US
Practice Address - Phone:210-896-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19440225100000X
SC9354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist