MEDICARE: THERESA ANNE MEYERS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PTA 23709	FL

General Provider Information

NPI Number	:	1619215761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ANNE MEYERS PTA

Provider Business Mailing Address
First Line	:	11366 EMILY'S CROSSING COURT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257
Country	:	US
Telephone Number	:	904-608-5602
Fax Number	:	904-292-2807

Provider Business Practice Location Address
First Line	:	11366 EMILYS CROSSING CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1530
Country	:	US
Telephone Number	:	904-608-5602
Fax Number	:	904-292-2807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	01/24/2013

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