Healthcare Provider Details

I. General information

NPI: 1245529569
Provider Name (Legal Business Name): MEADOWLAND THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 W QUINN RD
POCATELLO ID
83202-2425
US

IV. Provider business mailing address

1033 W QUINN RD
POCATELLO ID
83202-2425
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-4800
  • Fax: 208-233-4887
Mailing address:
  • Phone: 208-233-4800
  • Fax: 208-233-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD W LEMON
Title or Position: OWNER/CEO
Credential: MPT
Phone: 208-233-4800