Provider Demographics
NPI:1902359516
Name:MYERS, TERI (LMT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23807 HALL RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:OR
Mailing Address - Zip Code:97419-9737
Mailing Address - Country:US
Mailing Address - Phone:541-998-3162
Mailing Address - Fax:
Practice Address - Street 1:23807 HALL RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:OR
Practice Address - Zip Code:97419-9737
Practice Address - Country:US
Practice Address - Phone:541-998-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist