Provider Demographics
NPI:1477937720
Name:DECKER, MEREDITH
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 SWITCHYARD ST APT 329
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2282
Mailing Address - Country:US
Mailing Address - Phone:484-553-1893
Mailing Address - Fax:
Practice Address - Street 1:801 GREEK ROW DR
Practice Address - Street 2:BOX 19259
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-0001
Practice Address - Country:US
Practice Address - Phone:484-553-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT56912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer