Provider Demographics
NPI:1114624590
Name:MEIGH, MAXWELL RICHARD
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:RICHARD
Last Name:MEIGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26208 HARBOUR VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5130
Mailing Address - Country:US
Mailing Address - Phone:973-903-5911
Mailing Address - Fax:
Practice Address - Street 1:1000 PLANTATION ISLAND DR S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3106
Practice Address - Country:US
Practice Address - Phone:904-342-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist