Provider Demographics
NPI:1528118213
Name:MYERS, PATRICK CHRISTOPHER (PT, MS, OCS, COMT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:CHRISTOPHER
Last Name:MYERS
Suffix:
Gender:M
Credentials:PT, MS, OCS, COMT
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 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-759-7451
Mailing Address - Fax:812-759-7482
Practice Address - Street 1:175 S ENGLISH STATION RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4160
Practice Address - Country:US
Practice Address - Phone:502-222-8830
Practice Address - Fax:502-245-1146
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0040972251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11537OtherOCS CERTIFICATION
KY000000345889OtherANTHEM INDIVIDUAL NUMBER
KYKY4097OtherKY STATE LICENSE
KY000000946561OtherBLUE CROSS BLUE SHIELD
KY7100391470Medicaid
KY7100391470Medicaid
KYK145531Medicare PIN
KY11537OtherOCS CERTIFICATION