Provider Demographics
NPI:1801903166
Name:MYERS, STEVEN HARRY (MSPT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:HARRY
Last Name:MYERS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LA ROSA RD STE A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4000
Mailing Address - Country:US
Mailing Address - Phone:228-863-4080
Mailing Address - Fax:228-863-4014
Practice Address - Street 1:100 LA ROSA RD STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4000
Practice Address - Country:US
Practice Address - Phone:228-863-4080
Practice Address - Fax:228-863-4014
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00356883Medicaid
MS00356883Medicaid
MS20-3832089Medicare UPIN