Provider Demographics
NPI:1770303935
Name:MEYER, STEPHEN ANDREW
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANDREW
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 MILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-2204
Mailing Address - Country:US
Mailing Address - Phone:812-897-7158
Mailing Address - Fax:812-897-7361
Practice Address - Street 1:1116 MILLIS AVE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2204
Practice Address - Country:US
Practice Address - Phone:812-897-7158
Practice Address - Fax:812-897-7361
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007034A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist