Basic Information
Provider Information | |||||||||
NPI: | 1144433020 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DAVIS | ||||||||
FirstName: | MEGAN | ||||||||
MiddleName: | MILONE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | P.T. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1406 CRAIN HWY S STE 110 | ||||||||
Address2: |   | ||||||||
City: | GLEN BURNIE | ||||||||
State: | MD | ||||||||
PostalCode: | 210614086 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4107622124 | ||||||||
FaxNumber: | 4107055057 | ||||||||
Practice Location | |||||||||
Address1: | 1406 CRAIN HWY S STE 110 | ||||||||
Address2: |   | ||||||||
City: | GLEN BURNIE | ||||||||
State: | MD | ||||||||
PostalCode: | 21061 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4107622124 | ||||||||
FaxNumber: | 4107055057 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/08/2007 | ||||||||
LastUpdateDate: | 09/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15262 | MD | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | T982 | 01 | MD | CAREFIRST PROVIDER # | OTHER | J166 | 01 | MD | CAREFIRST PROVIDER # | OTHER |