Provider Demographics
NPI:1396047536
Name:MEIKLE, TANYA ANN MARIIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ANN MARIIE
Last Name:MEIKLE
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 1:906 MEBANE OAKS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7951
Mailing Address - Country:US
Mailing Address - Phone:919-563-1825
Mailing Address - Fax:919-563-1833
Practice Address - Street 1:3320 EXECUTIVE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-872-3747
Practice Address - Fax:919-872-3414
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25890225100000X
NC13585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982710562Medicaid
NC346512Medicare Oscar/Certification