Provider Demographics
NPI:1104251438
Name:HARDIE, MEREDITH L (DPT)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:HARDIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3415
Mailing Address - Country:US
Mailing Address - Phone:208-743-1795
Mailing Address - Fax:208-743-1791
Practice Address - Street 1:63-H LACEY ROAD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-716-0111
Practice Address - Fax:732-716-0114
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01509800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist