MEDICARE: MEREDITH BRANCH

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	306614	CA

General Provider Information

NPI Number	:	1780416826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH BRANCH

Provider Business Mailing Address
First Line	:	4560 LYRIC LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4010
Country	:	US
Telephone Number	:	704-473-4386
Fax Number	:

Provider Business Practice Location Address
First Line	:	5807 UNIVERSITY AVE STE 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6295
Country	:	US
Telephone Number	:	619-500-1098
Fax Number	:

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

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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Directions to “ MEREDITH BRANCH ” Practice Location

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