Provider Demographics
NPI:1508264466
Name:MYERS, TONIA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 RIVER WALK LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6815
Mailing Address - Country:US
Mailing Address - Phone:678-327-3674
Mailing Address - Fax:
Practice Address - Street 1:3780 RIVERCHASE VLG STE 500
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1209
Practice Address - Country:US
Practice Address - Phone:678-327-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL150065001744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management