Provider Demographics
NPI:1780336701
Name:MEADOR, NATALYE BROOKE (LPTA)
Entity type:Individual
Prefix:
First Name:NATALYE
Middle Name:BROOKE
Last Name:MEADOR
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 KEENELAND CT
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3838
Mailing Address - Country:US
Mailing Address - Phone:434-907-3306
Mailing Address - Fax:
Practice Address - Street 1:189 MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2213
Practice Address - Country:US
Practice Address - Phone:434-847-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605748208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation