Basic Information
Provider Information
NPI: 1003014945
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURGE
FirstName: MEGAN
MiddleName: ROCHELLE
NamePrefix: MRS.
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1960 W ELM TER
Address2:  
City: OLATHE
State: KS
PostalCode: 660613854
CountryCode: US
TelephoneNumber: 9137686196
FaxNumber:  
Practice Location
Address1: 10300 W 103RD ST STE 300
Address2:  
City: OVERLAND PARK
State: KS
PostalCode: 662142658
CountryCode: US
TelephoneNumber: 9138941910
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/03/2007
LastUpdateDate: 09/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X14-01515KSY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

ID Information
IDTypeStateIssuerDescription
200201926701MOSTATE LICENSEOTHER
14-0151501KSSTATE LICENSEOTHER


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