Provider Demographics
NPI:1023340445
Name:MYHR, DEBRA (PT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MYHR
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14330 OAKHILL PARK LN STE 115
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3479
Practice Address - Country:US
Practice Address - Phone:704-316-1265
Practice Address - Fax:704-316-1266
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16663225100000X
GAPT009866225100000X
GAAT0017202255A2300X
GAOT005078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA301111776A,B,C,DMedicaid
GA615921974AMedicaid
GA905098414AMedicaid
GA905098414AMedicaid