Provider Demographics
NPI:1861032062
Name:MEILICKE, PABLO CESAR (DPT)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:CESAR
Last Name:MEILICKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 E GREEN GABLES CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1145
Mailing Address - Country:US
Mailing Address - Phone:512-426-6642
Mailing Address - Fax:
Practice Address - Street 1:2990 RICHMOND AVE STE 432
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3115
Practice Address - Country:US
Practice Address - Phone:512-426-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist