Provider Demographics
NPI:1104193770
Name:MYERS, JENNIFER D (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
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 1:1485 COMMERCE PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-2883
Mailing Address - Country:US
Mailing Address - Phone:937-689-3971
Mailing Address - Fax:
Practice Address - Street 1:1485 COMMERCE PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2883
Practice Address - Country:US
Practice Address - Phone:937-689-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist