Provider Demographics
NPI:1689073322
Name:MYERS, LAUREL (PT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MAPLE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1205
Mailing Address - Country:US
Mailing Address - Phone:413-584-7234
Mailing Address - Fax:413-584-1896
Practice Address - Street 1:60 MAPLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1205
Practice Address - Country:US
Practice Address - Phone:413-584-7234
Practice Address - Fax:413-584-1896
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist