=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750757258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL MEIER PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2015
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 N RANDALL RD
-----------------------------------------------------
City | LAKE IN THE HILLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60156-5903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-854-8219
-----------------------------------------------------
Fax | 847-854-8278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 ENTERPRISE DR
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-8813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-575-6250
-----------------------------------------------------
Fax | 630-575-7450
-----------------------------------------------------
=====================================================
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 | 070-021505
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------