Provider Demographics
NPI:1558323337
Name:KOLLER, MEGAN LEE (DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:KOLLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LEE
Other - Last Name:NUTTALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-807-0366
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7234822OtherAETNA PPO
1837981OtherHIGHMARK BLUE SHIELD
2170544OtherMAMSI
2693619000OtherKEYSTONE HEALTH EAST
427548OtherHEALTHAMERICA/HEALTHASSUR
47241OtherGEISINGER HEALTH PLAN
50058560OtherCAPITAL BLUE CROSS
1837981OtherFIRST PRIORITY LIFE INS
2693619000OtherAMERIHEALTH
50058560OtherKEYSTONE HEALTH CENTRAL
P00354751OtherMEDICARE RAILROAD
820177OtherFIRST PRIORITY HEALTH
2734665OtherUNITED HEALTHCARE
8614788OtherCIGNA HEALTHCARE
P3686991OtherOXFORD HEALTH PLANS
2693619000OtherINDEPENDENCE BLUE CROSS
8614788OtherCIGNA HEALTHCARE