Provider Demographics
NPI:1528515244
Name:PACETTI, MEGAN (ATC, MS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PACETTI
Suffix:
Gender:F
Credentials:ATC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W LOOP 1604 N APT 6305
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3930
Mailing Address - Country:US
Mailing Address - Phone:708-837-9721
Mailing Address - Fax:
Practice Address - Street 1:3010 W LOOP 1604 N APT 6305
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3930
Practice Address - Country:US
Practice Address - Phone:708-837-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT84312255A2300X
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty