Provider Demographics
NPI:1851886683
Name:MEYER, ANTHONY JAMES
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12565 STATE ROUTE O
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-8115
Mailing Address - Country:US
Mailing Address - Phone:573-535-8470
Mailing Address - Fax:
Practice Address - Street 1:12565 STATE ROUTE O
Practice Address - Street 2:
Practice Address - City:SAINTE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-8115
Practice Address - Country:US
Practice Address - Phone:573-535-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-5792225100000X
MN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist