Provider Demographics
NPI:1548939713
Name:KILGORE, MEGAN ELISE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELISE
Last Name:KILGORE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:ELISE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:
Practice Address - Street 1:19510 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2974
Practice Address - Country:US
Practice Address - Phone:818-996-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist