Provider Demographics
NPI:1386317709
Name:MYER, MATTHEW S (PTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:MYER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:17902 GEORGIA AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2279
Mailing Address - Country:US
Mailing Address - Phone:240-774-0222
Mailing Address - Fax:
Practice Address - Street 1:14113 BALTIMORE AVE STE B
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5073
Practice Address - Country:US
Practice Address - Phone:301-347-4737
Practice Address - Fax:301-615-4747
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDA5404225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant