Provider Demographics
NPI:1720950223
Name:VINCENT, MEGAN (PTA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VINCENT
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 1:3719 STADIUM BLVD APT B14
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7923
Mailing Address - Country:US
Mailing Address - Phone:352-519-9122
Mailing Address - Fax:
Practice Address - Street 1:1502 AR-367
Practice Address - Street 2:
Practice Address - City:TUCKERMAN
Practice Address - State:AR
Practice Address - Zip Code:72473
Practice Address - Country:US
Practice Address - Phone:870-522-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA5072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant