Provider Demographics
NPI:1083440663
Name:MERIDITH, ABIGAIL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MERIDITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BERKLEY PKWY APT 119
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64120-1411
Mailing Address - Country:US
Mailing Address - Phone:407-790-8904
Mailing Address - Fax:
Practice Address - Street 1:220 NW R D MIZE RD STE B203
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2540
Practice Address - Country:US
Practice Address - Phone:816-220-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024036842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist