Provider Demographics
NPI:1053747477
Name:BALD, MEGAN ANNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ANNE
Last Name:BALD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OAK PARK CIR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4158
Mailing Address - Country:US
Mailing Address - Phone:954-295-7680
Mailing Address - Fax:
Practice Address - Street 1:750 OAK PARK CIR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4158
Practice Address - Country:US
Practice Address - Phone:954-295-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4821225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant