Provider Demographics
NPI:1801155619
Name:MYERS, MARTHA (PT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:BRUNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18068 W 92ND LN UNIT 200
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-8162
Mailing Address - Country:US
Mailing Address - Phone:720-497-6140
Mailing Address - Fax:
Practice Address - Street 1:18068 W 92ND LN UNIT 200
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-8162
Practice Address - Country:US
Practice Address - Phone:720-497-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7601225100000X
CO6701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist