Healthcare Provider Details

I. General information

NPI: 1619642071
Provider Name (Legal Business Name): JESSICA LYNN MEADOWS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WELTON WAY STE 2
MOORESVILLE NC
28117-9250
US

IV. Provider business mailing address

143 CEDAR RUN DR
TROUTMAN NC
28166-7634
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-6551
  • Fax:
Mailing address:
  • Phone: 704-660-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20653
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: