Provider Demographics
NPI:1366546061
Name:PRIDDY, MEGAN LYNN (ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:PRIDDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1437 TIPPECANOE ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-2246
Mailing Address - Country:US
Mailing Address - Phone:201-887-0492
Mailing Address - Fax:
Practice Address - Street 1:4TH AND CHESTNUT ST
Practice Address - Street 2:INDIANA STATE UNIVERSITY
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-0001
Practice Address - Country:US
Practice Address - Phone:812-237-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer