Provider Demographics
NPI:1336228782
Name:MEADOR, KAIULANI (PT)
Entity Type:Individual
Prefix:
First Name:KAIULANI
Middle Name:
Last Name:MEADOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAIULANI
Other - Middle Name:
Other - Last Name:MATHANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:800 FAIR PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1720
Mailing Address - Country:US
Mailing Address - Phone:501-604-6900
Mailing Address - Fax:
Practice Address - Street 1:10301 KANIS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6205
Practice Address - Country:US
Practice Address - Phone:501-604-6900
Practice Address - Fax:501-604-6941
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008824225100000X
ARPT3996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008824OtherSTATE LISC NUMBER