Provider Demographics
NPI:1801683800
Name:MYERS, JACK
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:MYERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2456 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-3066
Practice Address - Country:US
Practice Address - Phone:610-630-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist