Provider Demographics
NPI:1285900720
Name:MYERS, MICHELLE LYNN (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:WEINACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 S 37TH STREET
Mailing Address - Street 2:#505
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1269
Mailing Address - Country:US
Mailing Address - Phone:402-981-5742
Mailing Address - Fax:
Practice Address - Street 1:500 S 37TH STREET
Practice Address - Street 2:#505
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1269
Practice Address - Country:US
Practice Address - Phone:402-981-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1876225100000X
IA03150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist