Provider Demographics
NPI:1063459618
Name:MEADE, ROBERT REGINALD (ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:REGINALD
Last Name:MEADE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 SPRINGER RD
Mailing Address - Street 2:APT #18
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-5562
Mailing Address - Country:US
Mailing Address - Phone:563-581-0803
Mailing Address - Fax:
Practice Address - Street 1:765 N KELLOGG ST
Practice Address - Street 2:SUITE 300
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2875
Practice Address - Country:US
Practice Address - Phone:309-343-3434
Practice Address - Fax:309-343-3456
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer