Active NPI
Jeffery Gerard Meyer, PT
- Physical Therapist
- Lino Lakes, MN
National Provider Identifier
1972691608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5030
- Practice address
- 122 Palomino LN
Lino Lakes, MN 55014-2913 - Phone
- (651) 784-0862
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5030 | MN | Primary |
Addresses
Primary practice location
122 Palomino LN
Lino Lakes, MN 55014-2913
Mailing address
122 Palomino LN
Lino Lakes, MN 55014-2913
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 634554900 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5030 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297209600000",
"number": "1972691608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 PALOMINO LN",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550142913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 PALOMINO LN",
"city": "LINO LAKES",
"state": "MN",
"postal_code": "550142913",
"telephone_number": "651-784-0862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEYER",
"first_name": "JEFFERY",
"middle_name": "GERARD",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2011-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "5030",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "634554900",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lino Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.