Provider Demographics
NPI:1942304589
Name:MEADS, DAVID T (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:MEADS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N. ROBBINS DR
Mailing Address - Street 2:STE A
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041
Mailing Address - Country:US
Mailing Address - Phone:801-773-1350
Mailing Address - Fax:801-773-1351
Practice Address - Street 1:2121 N. ROBBINS DR
Practice Address - Street 2:STE A
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-773-1350
Practice Address - Fax:801-773-1351
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112594-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT519760352004Medicaid
UTAM0000027826OtherALTIUS INS
UT6400029OtherUHC INC