Basic Information
| Provider Information | |||||||||
| NPI: | 1326295460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | COX | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COX | ||||||||
| OtherFirstName: | MEGAN | ||||||||
| OtherMiddleName: | FIELDING | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1701 LIBRARY BLVD SUITE A | ||||||||
| Address2: | COLLABORATING FOR KIDS, LLC | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148400558 | ||||||||
| FaxNumber: | 6148409310 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 LIBRARY BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178819923 | ||||||||
| FaxNumber: | 6148409310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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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 | 2251P0200X | PT 012145 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2642626 | 05 | OH | MEDICAID |