Basic Information
Provider Information | |||||||||
NPI: | 1609154384 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEYER | ||||||||
FirstName: | ALLISON | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 8419 | ||||||||
Address2: |   | ||||||||
City: | BILOXI | ||||||||
State: | MS | ||||||||
PostalCode: | 395358087 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2283885714 | ||||||||
FaxNumber: | 2283880017 | ||||||||
Practice Location | |||||||||
Address1: | 7127 U S HIGHWAY 98 | ||||||||
Address2: | SUITE 30 | ||||||||
City: | HATTIESBURG | ||||||||
State: | MS | ||||||||
PostalCode: | 394027033 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6012680208 | ||||||||
FaxNumber: | 6012680440 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2011 | ||||||||
LastUpdateDate: | 07/28/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT4869 | MS | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 09015077 | 05 | MS |   | MEDICAID | 1033218524 | 01 | MS | GROUP NPI | OTHER |