Provider Demographics
NPI:1760133169
Name:SPAIN, MEGAN (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SPAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:KRAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7 CEDARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2603
Mailing Address - Country:US
Mailing Address - Phone:414-840-8160
Mailing Address - Fax:
Practice Address - Street 1:13200 GLOBE DR STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1615
Practice Address - Country:US
Practice Address - Phone:414-840-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI12026-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist