Provider Demographics
NPI:1407144397
Name:MEARIDA, JARED D (MPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:D
Last Name:MEARIDA
Suffix:
Gender:M
Credentials:MPT
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 94
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61358-0094
Mailing Address - Country:US
Mailing Address - Phone:309-825-0319
Mailing Address - Fax:
Practice Address - Street 1:146 MOORESVILLE COMMONS WAY STE 5E
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8938
Practice Address - Country:US
Practice Address - Phone:980-444-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018542225100000X
NCP21912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist