Provider Demographics
NPI:1174672513
Name:MEADOWS, HOLLY S (PT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:S
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 RICHARD PL
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3130
Mailing Address - Country:US
Mailing Address - Phone:607-277-0629
Mailing Address - Fax:
Practice Address - Street 1:419 RICHARD PL
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3130
Practice Address - Country:US
Practice Address - Phone:607-277-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021103-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0953Medicare ID - Type Unspecified