Provider Demographics
NPI:1699535617
Name:MYRAN, MCKENNA J (PT, DPT)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:J
Last Name:MYRAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:J
Other - Last Name:WEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1120 11TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3652
Mailing Address - Country:US
Mailing Address - Phone:701-690-2538
Mailing Address - Fax:
Practice Address - Street 1:1340 W VILLARD ST STE B
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4632
Practice Address - Country:US
Practice Address - Phone:701-495-3611
Practice Address - Fax:701-483-4281
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist