Organization
MEADOWS PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE MARIE RIGGS (BUSINESS MANAGER)
(707) 462-4996
Entity
Organization
Contact information
Practice address
1252 AIRPORT PARK BLVD STE A1, UKIAH, CA 95482-5979
(707) 462-4996
(707) 462-0485
Mailing address
1252 AIRPORT PARK BLVD STE A1, UKIAH, CA 95482-5979
(707) 462-4996
(707) 462-0485
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001020
—
CA
01
—
ZZZ65370Z
BLUE SHIELD PROVIDER NUMB
CA
Enumeration date
09/20/2006
Last updated
08/22/2020
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