Provider Demographics
NPI:1285120303
Name:DISHMAN, MEGAN BROOKE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BROOKE
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 ALTAVISTA LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-1398
Mailing Address - Country:US
Mailing Address - Phone:931-409-1858
Mailing Address - Fax:
Practice Address - Street 1:2080 ALDI BLVD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7119
Practice Address - Country:US
Practice Address - Phone:931-409-1858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN26642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN933206266OtherUNITED HEALTHCARE