Provider Demographics
NPI:1699919001
Name:MYERS, MICHELLE LEE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1638
Mailing Address - Country:US
Mailing Address - Phone:216-271-1133
Mailing Address - Fax:216-271-1325
Practice Address - Street 1:3366 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1638
Practice Address - Country:US
Practice Address - Phone:216-271-1133
Practice Address - Fax:216-271-1325
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13531171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor