Provider Demographics
NPI:1811063506
Name:MEYER, JEREMY JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOSEPH
Last Name:MEYER
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 1:1020 LUKE ST
Mailing Address - Street 2:STE B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4067
Mailing Address - Country:US
Mailing Address - Phone:970-223-2484
Mailing Address - Fax:970-223-6156
Practice Address - Street 1:1020 LUKE ST
Practice Address - Street 2:STE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4067
Practice Address - Country:US
Practice Address - Phone:970-223-2484
Practice Address - Fax:970-223-6156
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62328239Medicaid
CO800677Medicare ID - Type Unspecified