Provider Demographics
NPI:1235406182
Name:LYMER, MEREDITH MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MICHELE
Last Name:LYMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:MICHELE
Other - Last Name:WAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2624 PROSPECT HEIGHTS DR APT 14303
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-7428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2624 PROSPECT HEIGHTS DR APT 14303
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-7428
Practice Address - Country:US
Practice Address - Phone:512-585-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1207768225100000X
CA39820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist