MEDICARE: JEFFERY GERARD MEYER 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	5030	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972691608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY GERARD MEYER PT

Provider Business Mailing Address
First Line	:	122 PALOMINO LN
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55014-2913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 PALOMINO LN
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55014-2913
Country	:	US
Telephone Number	:	651-784-0862
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	02/09/2011

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