Provider Demographics
NPI:1508274168
Name:MCINNIS, MEREDITH STERLING-SWAIN
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:STERLING-SWAIN
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:STERLING
Other - Last Name:SWAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3715 PATRIOT WAY
Mailing Address - Street 2:# 141
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6907
Mailing Address - Country:US
Mailing Address - Phone:910-769-2483
Mailing Address - Fax:
Practice Address - Street 1:3715 PATRIOT WAY
Practice Address - Street 2:# 141
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6907
Practice Address - Country:US
Practice Address - Phone:910-769-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist