Provider Demographics
NPI:1467013359
Name:MYERS, MONTEO FAJOTO (LMT, CLT-LANA)
Entity Type:Individual
Prefix:MR
First Name:MONTEO
Middle Name:FAJOTO
Last Name:MYERS
Suffix:
Gender:M
Credentials:LMT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HEATHER RD STE 206
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3009
Mailing Address - Country:US
Mailing Address - Phone:215-680-5305
Mailing Address - Fax:856-629-0539
Practice Address - Street 1:133 HEATHER RD STE 206
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3009
Practice Address - Country:US
Practice Address - Phone:215-680-5305
Practice Address - Fax:856-629-0539
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist