Provider Demographics
NPI:1003378324
Name:MEYERS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MEYERS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONALOY
Authorized Official - Suffix:
Authorized Official - Credentials:PT CIMT
Authorized Official - Phone:530-721-3253
Mailing Address - Street 1:PO BOX 550275
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96155-0275
Mailing Address - Country:US
Mailing Address - Phone:530-721-3253
Mailing Address - Fax:530-285-2002
Practice Address - Street 1:2311 LAKE TAHOE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7104
Practice Address - Country:US
Practice Address - Phone:530-721-3253
Practice Address - Fax:530-285-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy