Provider Demographics
NPI:1881961928
Name:MYERS, LAURA MICHELE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELE
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELE
Other - Last Name:MUSCATELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-929-3351
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:4253 ROUTE 9 N
Practice Address - Street 2:BLDG 4 UNIT A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8309
Practice Address - Country:US
Practice Address - Phone:732-780-9033
Practice Address - Fax:732-780-8680
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01425500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist