Provider Demographics
NPI:1447360409
Name:VAN WART, MEGAN MCBROOM (MS, ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MCBROOM
Last Name:VAN WART
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 COUNTRY DAY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4201
Mailing Address - Country:US
Mailing Address - Phone:817-302-3265
Mailing Address - Fax:817-302-3279
Practice Address - Street 1:4200 COUNTRY DAY LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4201
Practice Address - Country:US
Practice Address - Phone:817-302-3265
Practice Address - Fax:817-302-3279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT1943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist