Provider Demographics
NPI:1285010595
Name:ROBERTSON, MEGAN B (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:B
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:B
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:205 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-8900
Mailing Address - Country:US
Mailing Address - Phone:270-524-7800
Mailing Address - Fax:
Practice Address - Street 1:205 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-8900
Practice Address - Country:US
Practice Address - Phone:270-524-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist