Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11748 | CO |
N | 2251S0007X | Physical Therapist - Sports | 11748 | CO |
NPI | 1386994788 |
---|---|
Provider Name | Meredith Joe Dake |
First Address | Highlands Ranch, CO 80129-2450 |
Second Address | Highlands Ranch, CO 80129-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 17/10/2019 |