Provider Demographics
NPI:1043636145
Name:KOLUMBUS, MEGHAN M (ATC)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:M
Last Name:KOLUMBUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:560 S MAPLE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1733
Mailing Address - Country:US
Mailing Address - Phone:952-442-2163
Mailing Address - Fax:952-442-5903
Practice Address - Street 1:560 S MAPLE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1733
Practice Address - Country:US
Practice Address - Phone:952-442-2163
Practice Address - Fax:952-442-5903
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer