Provider Demographics
NPI:1275245342
Name:MYERS, HAROLD JOHN III (PT)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:JOHN
Last Name:MYERS
Suffix:III
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:PO BOX 5360
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-5360
Mailing Address - Country:US
Mailing Address - Phone:903-753-6635
Mailing Address - Fax:903-753-1114
Practice Address - Street 1:9 WOODMONT CROSSING ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2136
Practice Address - Country:US
Practice Address - Phone:903-753-6635
Practice Address - Fax:903-753-1114
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1096709OtherTEXAS BOARD OF PHYSICAL THERAPY