Provider Demographics
NPI:1376150581
Name:MERIDIAN MAMA'S PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MERIDIAN MAMA'S PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HUXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:352-302-9517
Mailing Address - Street 1:1120 FOREST AVE
Mailing Address - Street 2:PMB 215
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950
Mailing Address - Country:US
Mailing Address - Phone:352-302-9517
Mailing Address - Fax:
Practice Address - Street 1:309 W EMMA AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2522
Practice Address - Country:US
Practice Address - Phone:352-302-9517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy