Healthcare Provider Details

I. General information

NPI: 1972153419
Provider Name (Legal Business Name): MEREDITH ELISE BLAND DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 ERWIN RD
DURHAM NC
27705-0005
US

IV. Provider business mailing address

3475 ERWIN RD
DURHAM NC
27705-0005
US

V. Phone/Fax

Practice location:
  • Phone: 888-275-3853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2305213131
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: