Provider Demographics
NPI:1932431442
Name:MEADORS, DAVID LUDWELL (LMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LUDWELL
Last Name:MEADORS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 ATLANTIC BLVD
Mailing Address - Street 2:APT 2
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5364
Mailing Address - Country:US
Mailing Address - Phone:305-731-9733
Mailing Address - Fax:
Practice Address - Street 1:1805 ATLANTIC BLVD
Practice Address - Street 2:APT 2
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-5364
Practice Address - Country:US
Practice Address - Phone:305-731-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist