Basic Information
| Provider Information | |||||||||
| NPI: | 1316401474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANCILL | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | STANCILL | ||||||||
| OtherFirstName: | MEGAN | ||||||||
| OtherMiddleName: | WULKOW | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 95 UNIVERSITY PL FL 8 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100034515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126041316 | ||||||||
| FaxNumber: | 2126041320 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 W 40TH ST STE 352 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212112100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102435399 | ||||||||
| FaxNumber: | 4102435366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2019 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 35585 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 28842 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.