Provider Demographics
NPI:1093413148
Name:MYERS, AMY JOLENE (PTA, LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOLENE
Last Name:MYERS
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:WILBER
Practice Address - State:NE
Practice Address - Zip Code:68465
Practice Address - Country:US
Practice Address - Phone:402-821-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1033225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant