Provider Demographics
NPI:1205540457
Name:MYERS, GARY (LMT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ADALIA AVE APT 407
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3315
Mailing Address - Country:US
Mailing Address - Phone:813-600-7998
Mailing Address - Fax:
Practice Address - Street 1:2 ADALIA AVE APT 407
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3315
Practice Address - Country:US
Practice Address - Phone:813-600-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83979225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist