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General NPI Number Information
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NPI Number | 1356893051
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Entity Type | Individual
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Provider Name | JEFFERSON W MEADORS PTA
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Gender | Male
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 909 SAGAMORE PKWY W STE 917
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1443
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Country | US
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Telephone | 765-463-0710
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Fax | 765-463-0711
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | CP032352A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.011065
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License Number State | OH
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