Provider Demographics
NPI:1558683516
Name:MEEKMA, HALEY E (DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:E
Last Name:MEEKMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:E
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-590-4029
Mailing Address - Fax:
Practice Address - Street 1:1135 PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3973
Practice Address - Country:US
Practice Address - Phone:262-886-6780
Practice Address - Fax:262-886-6710
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11382-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI830420092Medicare PIN