Provider Demographics
NPI:1699890871
Name:JOHNSON, MEGAN A (ATC)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61973 STATE ROUTE 415
Mailing Address - Street 2:
Mailing Address - City:COHOCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14826-9688
Mailing Address - Country:US
Mailing Address - Phone:814-725-6111
Mailing Address - Fax:814-725-6373
Practice Address - Street 1:16 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1008
Practice Address - Country:US
Practice Address - Phone:814-725-6111
Practice Address - Fax:814-725-6373
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist