Provider Demographics
NPI:1124104716
Name:MYERS, MICHELE RENEE (PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEE
Last Name:MYERS
Suffix:
Gender:F
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:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:HECTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14841-0202
Mailing Address - Country:US
Mailing Address - Phone:607-742-3992
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:6095 CLUB 15 RD
Practice Address - Street 2:
Practice Address - City:HECTOR
Practice Address - State:NY
Practice Address - Zip Code:14841
Practice Address - Country:US
Practice Address - Phone:607-742-3992
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0113441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist