Provider Demographics
NPI:1629289715
Name:MEADOWS CLINIC AT LAWRENCEVILLE LLC
Entity type:Organization
Organization Name:MEADOWS CLINIC AT LAWRENCEVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPASI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD, CHT
Authorized Official - Phone:770-623-0105
Mailing Address - Street 1:1430 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:STE 210
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8183
Mailing Address - Country:US
Mailing Address - Phone:678-377-1738
Mailing Address - Fax:378-377-1737
Practice Address - Street 1:1430 FIVE FORKS TRICKUM RD
Practice Address - Street 2:STE 210
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8183
Practice Address - Country:US
Practice Address - Phone:678-377-1738
Practice Address - Fax:678-377-1737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEADOWS HAND AND PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004486225100000X, 2251H1200X
GAPT005934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBMFMedicare ID - Type Unspecified
GAGRP6380Medicare ID - Type Unspecified
GA65BBDSZMedicare ID - Type Unspecified
GA5163970002Medicare NSC