Provider Demographics
NPI:1841412657
Name:MYERS, JOSEPH ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALAN
Last Name:MYERS
Suffix:
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 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4722
Practice Address - Country:US
Practice Address - Phone:989-631-3570
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501011065OtherSTATE LICENSE NUMBER
MIN75070019OtherMEDICARE PTAN