Provider Demographics
NPI:1083952675
Name:MYERS, SUE (LMBT #8074 NC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMBT #8074 NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 STALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9336
Mailing Address - Country:US
Mailing Address - Phone:704-791-3697
Mailing Address - Fax:
Practice Address - Street 1:4934 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8464
Practice Address - Country:US
Practice Address - Phone:704-791-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8074225700000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist