MEDICARE: SIARRA MECKLEY PT

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	225100000X	Physical Therapist	40513	FL

General Provider Information

NPI Number	:	1689148884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIARRA MECKLEY PT

Provider Business Mailing Address
First Line	:	1004 DARTMOUTH DR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-5212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 DARTMOUTH DR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-5212
Country	:	US
Telephone Number	:	860-336-1048
Fax Number	:

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

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	03/24/2026

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Directions to “ SIARRA MECKLEY PT” Practice Location

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