Provider Demographics
NPI:1427371749
Name:MEIVES, CALEB JOEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:JOEL
Last Name:MEIVES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1869
Mailing Address - Country:US
Mailing Address - Phone:765-327-1156
Mailing Address - Fax:
Practice Address - Street 1:604 RENNAKER ST
Practice Address - Street 2:
Practice Address - City:LA FONTAINE
Practice Address - State:IN
Practice Address - Zip Code:46940-9045
Practice Address - Country:US
Practice Address - Phone:800-283-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004035A171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor