MEDICARE: KATIE MEYER PT, DPT

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	225100000X	Physical Therapist	2305208413	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2305208413	OTHER	VA	STATE LICENSE

General Provider Information

NPI Number	:	1356756969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MEYER PT, DPT

Provider Business Mailing Address
First Line	:	4633 PEMBROKE LAKE CIR STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6404
Country	:	US
Telephone Number	:	757-689-7446
Fax Number	:

Provider Business Practice Location Address
First Line	:	4633 PEMBROKE LAKE CIR STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6404
Country	:	US
Telephone Number	:	757-689-7446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	05/23/2025

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