Provider Demographics
NPI:1194380394
Name:MILLSAP, MEGAN E (DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:ROBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6419 LAKEWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3331
Mailing Address - Country:US
Mailing Address - Phone:541-844-4730
Mailing Address - Fax:
Practice Address - Street 1:6419 LAKEWOOD DR W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3331
Practice Address - Country:US
Practice Address - Phone:532-531-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4456225100000X
OR62289225100000X
WA609652782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist