Provider Demographics
NPI:1063062867
Name:MYERS, COURTNEY RENEE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RENEE
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:VILLISCA
Mailing Address - State:IA
Mailing Address - Zip Code:50864-1018
Mailing Address - Country:US
Mailing Address - Phone:712-621-6582
Mailing Address - Fax:
Practice Address - Street 1:113 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:VILLISCA
Practice Address - State:IA
Practice Address - Zip Code:50864-1018
Practice Address - Country:US
Practice Address - Phone:712-621-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081921225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty