Provider Demographics
NPI:1720304199
Name:HUFNAGEL, MYRA-LYNN (PT,DPT, CERTMDT)
Entity Type:Individual
Prefix:
First Name:MYRA-LYNN
Middle Name:
Last Name:HUFNAGEL
Suffix:
Gender:F
Credentials:PT,DPT, CERTMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6069 WOODPECKER CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6221
Mailing Address - Country:US
Mailing Address - Phone:734-754-1479
Mailing Address - Fax:
Practice Address - Street 1:6069 WOODPECKER CT
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6221
Practice Address - Country:US
Practice Address - Phone:734-754-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist