MEDICARE: MRS. MEREDITH LOTT DENDINGER 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	PT5173	MS
2	2251P0200X	Pediatric Physical Therapist	PT5173	MS

General Provider Information

NPI Number	:	1518309442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEREDITH LOTT DENDINGER PT, DPT

Provider Business Mailing Address
First Line	:	1806 LINDEN PL
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-1219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1806 LINDEN PL
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-1219
Country	:	US
Telephone Number	:	662-458-5654
Fax Number	:

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/19/2013

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