Provider Demographics
NPI:1710975123
Name:MEREDITH, MARK A (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MEAGHER AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6228
Mailing Address - Country:US
Mailing Address - Phone:406-585-8689
Mailing Address - Fax:
Practice Address - Street 1:207 MEAGHER AVE
Practice Address - Street 2:205 N. 11TH AVE
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6228
Practice Address - Country:US
Practice Address - Phone:406-585-8689
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer