Provider Demographics
NPI:1205417193
Name:MYERS, MELISSA JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:MYERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:270 SUSQUEHANNA VALLEY MALL DR STE 400
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9115
Practice Address - Country:US
Practice Address - Phone:570-884-7940
Practice Address - Fax:570-884-8360
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT029456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1Q9994OtherMEDICARE
PA103900015Medicaid