Provider Demographics
NPI:1083647598
Name:MYERS, ELIZABETH LEE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LEE
Other - Last Name:HOUCHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:418 3RD ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3585
Mailing Address - Country:US
Mailing Address - Phone:907-374-0225
Mailing Address - Fax:907-308-4025
Practice Address - Street 1:418 3RD ST STE 1B
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3585
Practice Address - Country:US
Practice Address - Phone:907-374-0225
Practice Address - Fax:907-308-4025
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1871225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8912781Medicare PIN