Provider Demographics
NPI:1346073095
Name:MEYER, PETER BOYSWORTH (LMT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:BOYSWORTH
Last Name:MEYER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 GULFBREEZE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78402-1517
Mailing Address - Country:US
Mailing Address - Phone:361-815-1975
Mailing Address - Fax:
Practice Address - Street 1:4646 CORONA DR STE 172
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4361
Practice Address - Country:US
Practice Address - Phone:361-947-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT103538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist