Provider Demographics
NPI:1295323871
Name:MEEKER, MEKAYLA ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEKAYLA
Middle Name:ROSE
Last Name:MEEKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 W BUCHANAN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-9228
Mailing Address - Country:US
Mailing Address - Phone:231-233-1049
Mailing Address - Fax:
Practice Address - Street 1:710 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1175
Practice Address - Country:US
Practice Address - Phone:231-873-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist