Basic Information
Provider Information
NPI: 1891009353
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FORSEE
FirstName: MEGAN
MiddleName: DANIELLE
NamePrefix: MRS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WAINSCOTT
OtherFirstName: MEGAN
OtherMiddleName: DANIELLE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: DPT
OtherLastNameType: 1
Mailing Information
Address1: 3301 BERRYWOOD DR
Address2: SUITE 204
City: COLUMBIA
State: MO
PostalCode: 652016517
CountryCode: US
TelephoneNumber: 5734496082
FaxNumber: 5734490401
Practice Location
Address1: 1238 REMINGTON DR
Address2:  
City: CENTRALIA
State: MO
PostalCode: 652401486
CountryCode: US
TelephoneNumber: 5736822230
FaxNumber: 5736829580
Other Information
ProviderEnumerationDate: 07/27/2010
LastUpdateDate: 03/24/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X2010024371MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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