Healthcare Provider Details

I. General information

NPI: 1124837299
Provider Name (Legal Business Name): MEREDITH RICHARD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 GARRISONVILLE RD STE 211
STAFFORD VA
22554-1576
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 540-602-4277
  • Fax:
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216880
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: