Provider Demographics
NPI:1043984453
Name:MEAD, ELI P (DPT)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:P
Last Name:MEAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E BIDWELL ST STE 130
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3897
Mailing Address - Country:US
Mailing Address - Phone:916-853-0255
Mailing Address - Fax:
Practice Address - Street 1:801 STERLING PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7328
Practice Address - Country:US
Practice Address - Phone:916-543-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist