Provider Demographics
NPI:1891334934
Name:MYERS, PATTI (PTA)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4465
Mailing Address - Country:US
Mailing Address - Phone:716-683-9315
Mailing Address - Fax:716-683-7961
Practice Address - Street 1:5102 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4465
Practice Address - Country:US
Practice Address - Phone:716-683-9315
Practice Address - Fax:716-683-7961
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011664225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant