Basic Information
| Provider Information | |||||||||
| NPI: | 1679753503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOSO | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | PT | ||||||||
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| OtherLastName: | PLOEHN | ||||||||
| OtherFirstName: | MEGAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 103 N MAIN ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645285700 | ||||||||
| FaxNumber: | 8645285701 | ||||||||
| Practice Location | |||||||||
| Address1: | 2660 REIDVILLE RD | ||||||||
| Address2: | STE 6 & 7 | ||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293013512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645763738 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5620 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.