Provider Demographics
NPI:1699097519
Name:ECHTERNACH, MEGAN RENEE (PTA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:ECHTERNACH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20528 BOLAND FARM RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4021
Mailing Address - Country:US
Mailing Address - Phone:301-528-8096
Mailing Address - Fax:301-528-8083
Practice Address - Street 1:20528 BOLAND FARM RD
Practice Address - Street 2:SUITE 111
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4021
Practice Address - Country:US
Practice Address - Phone:301-528-8096
Practice Address - Fax:301-528-8083
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000285225200000X
MDA3489225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant