Provider Demographics
NPI:1639831647
Name:WALN, MEREDITH (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:MEREDITH
Middle Name:
Last Name:WALN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10023 BELLE RIVE BLVD APT 1109
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9579
Mailing Address - Country:US
Mailing Address - Phone:239-878-5825
Mailing Address - Fax:
Practice Address - Street 1:3351 HENDRICKS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5301
Practice Address - Country:US
Practice Address - Phone:904-402-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL42552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer