Provider Demographics
NPI:1861181141
Name:JOHNSON, MARGUERITE MEGHAN ROSE (MA, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:MEGHAN ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 STRASSBURGER RD
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1925
Mailing Address - Country:US
Mailing Address - Phone:267-374-3990
Mailing Address - Fax:
Practice Address - Street 1:275 S ITHAN AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1099
Practice Address - Country:US
Practice Address - Phone:610-801-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0075252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer