Provider Demographics
NPI:1124038658
Name:MYERS, WILLIAM RAY II (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAY
Last Name:MYERS
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4005
Mailing Address - Country:US
Mailing Address - Phone:806-274-3737
Mailing Address - Fax:806-274-3750
Practice Address - Street 1:511 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4005
Practice Address - Country:US
Practice Address - Phone:806-274-3737
Practice Address - Fax:806-274-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1051316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087732601Medicaid
TX659944OtherBCBS
TX102573102OtherFIRSTCARE
TX087732601Medicaid