Provider Demographics
NPI:1962610394
Name:MEYER, CHRISTA ANN (MPT)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:ANN
Last Name:MEYER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 N LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-2955
Mailing Address - Country:US
Mailing Address - Phone:317-213-9006
Mailing Address - Fax:
Practice Address - Street 1:1449 N LELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2955
Practice Address - Country:US
Practice Address - Phone:317-213-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008325A225100000X
WAPT00010047225100000X
CA32703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist