Provider Demographics
NPI:1477764447
Name:MEREDITH, DANIEL R (PT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:MEREDITH
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 1:715 DISCOVERY BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2417
Mailing Address - Country:US
Mailing Address - Phone:512-260-9600
Mailing Address - Fax:512-260-9601
Practice Address - Street 1:700 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6032
Practice Address - Country:US
Practice Address - Phone:512-260-9600
Practice Address - Fax:512-260-9601
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX262306Medicare PIN
TX8B9080Medicare ID - Type UnspecifiedSPECIALTY 65