=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073792396
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAMON MEIER MPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2007
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1140 COLLINSVILLE CROSSING BLVD
-----------------------------------------------------
City | COLLINSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62234-1880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-578-5900
-----------------------------------------------------
Fax | 618-578-5901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2122 YORK RD STE 300
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-575-1980
-----------------------------------------------------
Fax | 636-916-4628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070.018733
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2008001020
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------