Basic Information
| Provider Information | |||||||||
| NPI: | 1124104716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STEUBEN ST | ||||||||
| Address2: | |||||||||
| City: | MONTOUR FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075358616 | ||||||||
| FaxNumber: | 6072101965 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 STEUBEN ST | ||||||||
| Address2: | SCHUYLER HOSPITAL | ||||||||
| City: | MONTOUR FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075359453 | ||||||||
| FaxNumber: | 6072101965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0113441 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.