Provider Demographics
NPI:1730363789
Name:MEISENHEIMER, TRISHA LYNN (MPT)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:LYNN
Last Name:MEISENHEIMER
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 1:250 HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:65046-1211
Mailing Address - Country:US
Mailing Address - Phone:660-849-9101
Mailing Address - Fax:
Practice Address - Street 1:101 S OWEN ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-1150
Practice Address - Country:US
Practice Address - Phone:573-796-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006032142390200000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program