Provider Demographics
NPI:1720405624
Name:MYERS, TANYA ANNE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ANNE
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:BOLIG
Other - Suffix:
Other - Last Name Type:Former Name
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 1:100 HISTORIC DR
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:PA
Practice Address - Zip Code:17579-1458
Practice Address - Country:US
Practice Address - Phone:717-687-6657
Practice Address - Fax:717-687-6659
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA789776OtherMEDICARE PTAN
PA1034217510028Medicaid