Provider Demographics
NPI:1003564428
Name:MEIER, MICHELLE DAWN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:MEIER
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 1:1001 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESOPUS
Mailing Address - State:NY
Mailing Address - Zip Code:12429-2500
Mailing Address - Country:US
Mailing Address - Phone:347-501-2895
Mailing Address - Fax:
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:
Practice Address - City:ESOPUS
Practice Address - State:NY
Practice Address - Zip Code:12429-2500
Practice Address - Country:US
Practice Address - Phone:347-501-2895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047519-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist