Provider Demographics
NPI:1730324898
Name:GAILLIARD, MEGAN BETH (MPT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BETH
Last Name:GAILLIARD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:BETH
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25750 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033
Mailing Address - Country:US
Mailing Address - Phone:248-415-2500
Mailing Address - Fax:248-357-3243
Practice Address - Street 1:25750 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:248-415-2500
Practice Address - Fax:248-357-3243
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist