Provider Demographics
NPI:1023664182
Name:MEADORS, EDWARD PAUL JR (DPT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:PAUL
Last Name:MEADORS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 BREAM AVE UNIT G
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-6125
Mailing Address - Country:US
Mailing Address - Phone:765-716-8328
Mailing Address - Fax:
Practice Address - Street 1:1110 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6742
Practice Address - Country:US
Practice Address - Phone:850-563-8129
Practice Address - Fax:850-314-6364
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist