Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT020486 | PA |
NPI | 1003134826 |
---|---|
Provider Name | Meredith Mayes |
First Address | Philadelphia, PA 19147-1568 |
Second Address | Philadelphia, PA 19147-1568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2010 |
Last Update Date | 05/05/2010 |