Provider Demographics
NPI:1104961408
Name:MYERS, DEAN ALAN (PT)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:ALAN
Last Name:MYERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2797
Mailing Address - Country:US
Mailing Address - Phone:360-293-3174
Mailing Address - Fax:360-293-4418
Practice Address - Street 1:1105 27TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2797
Practice Address - Country:US
Practice Address - Phone:360-293-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2041225100000X
WAPT 00007036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1040879Medicaid
WAG8941886Medicare PIN