Provider Demographics
NPI:1972498442
Name:MERADITH, STANFORD (DPT)
Entity type:Individual
Prefix:
First Name:STANFORD
Middle Name:
Last Name:MERADITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 CEDAR COVE RD APT 4081411
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-7857
Mailing Address - Country:US
Mailing Address - Phone:402-699-8799
Mailing Address - Fax:
Practice Address - Street 1:2550 SUPERIOR ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4155
Practice Address - Country:US
Practice Address - Phone:402-476-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic