Provider Demographics
NPI:1346463809
Name:MEZA, JOSEPH L (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:MEZA
Suffix:
Gender:M
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:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-1193
Mailing Address - Country:US
Mailing Address - Phone:281-334-2560
Mailing Address - Fax:281-238-8401
Practice Address - Street 1:3000 INVINCIBLE CIR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2956
Practice Address - Country:US
Practice Address - Phone:281-334-2560
Practice Address - Fax:281-238-8401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPT143867OtherWORKERS COMP
TXP00200127OtherRAILROAD MEDICARE
TX658373OtherBLUE CROSS BLUE SHIELD
TXP00200127OtherRAILROAD MEDICARE