Provider Demographics
NPI:1730856030
Name:MEEKS, EMMA NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:NICOLE
Last Name:MEEKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 E REDSTONE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5372
Mailing Address - Country:US
Mailing Address - Phone:850-689-3127
Mailing Address - Fax:
Practice Address - Street 1:184 E REDSTONE AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5372
Practice Address - Country:US
Practice Address - Phone:850-689-3127
Practice Address - Fax:850-689-8504
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist