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Individual
MEREDITH A. TICE
Active
Individual
MEREDITH A. TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305211043
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05954
MEDICARE GROUP PTAN
VA
Enumeration date
07/10/2017
Last updated
05/04/2018
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