Provider Demographics
NPI:1699911321
Name:ISENBERG, MEGAN EMILY (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILY
Last Name:ISENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:EMILY
Other - Last Name:NESTLERODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1301 LAKE BOWEN DAM RD
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-7348
Mailing Address - Country:US
Mailing Address - Phone:301-466-2534
Mailing Address - Fax:
Practice Address - Street 1:530 HOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2000
Practice Address - Country:US
Practice Address - Phone:864-268-8196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406409700Medicaid