=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730042722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER NICOLE MEADE PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 HARRIER AVE
-----------------------------------------------------
City | SATELLITE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32937-2885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-314-4208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 990 HARRIER AVE
-----------------------------------------------------
City | SATELLITE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32937-2885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-314-4208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA34189
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------