Basic Information
Provider Information
NPI: 1992197339
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEYER
FirstName: KARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1475
Address2:  
City: DES MOINES
State: IA
PostalCode: 503051475
CountryCode: US
TelephoneNumber: 5152227350
FaxNumber: 5152227355
Practice Location
Address1: 1601 NW 114TH STREET
Address2: SUITE 155
City: CLIVE
State: IA
PostalCode: 503257046
CountryCode: US
TelephoneNumber: 5152227350
FaxNumber: 5152227355
Other Information
ProviderEnumerationDate: 02/23/2015
LastUpdateDate: 02/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X005100IAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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