Provider Demographics
NPI:1548656051
Name:VETTER, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W FIRESTORM WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3216
Mailing Address - Country:US
Mailing Address - Phone:623-385-9543
Mailing Address - Fax:
Practice Address - Street 1:61 FOSTER CANYON RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-6195
Practice Address - Country:US
Practice Address - Phone:623-385-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer