MEDICARE: MEADOWS PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ65370Z	OTHER	CA	BLUE SHIELD PROVIDER NUMB

General Provider Information

NPI Number	:	1306943287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWS PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	1252 AIRPORT PARK BLVD STE A1
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-5979
Country	:	US
Telephone Number	:	707-462-4996
Fax Number	:	707-462-0485

Provider Business Practice Location Address
First Line	:	1252 AIRPORT PARK BLVD STE A1
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-5979
Country	:	US
Telephone Number	:	707-462-4996
Fax Number	:	707-462-0485

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	TRACIE MARIE RIGGS
Credential	:
Telephone Number	:	707-462-4996

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “MEADOWS PHYSICAL THERAPY, INC. ” Practice Location

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