MEDICARE: MR. NICOLAS MYRIANTHIS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	473	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	D10639	OTHER	HI	HMSA PAHOA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	A10635	OTHER	HI	HMSA MAIN

General Provider Information

NPI Number	:	1518979871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICOLAS MYRIANTHIS PT

Provider Business Mailing Address
First Line	:	339 ALAWAENA ST
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-3506
Country	:	US
Telephone Number	:	808-959-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	15-2866 GOVERNMENT MAIN ROAD
Second Line	:	PAHOA VILLAGE CENTER
City	:	PAHOA
State	:	HI
Zip	:	96778
Country	:	US
Telephone Number	:	808-965-0880
Fax Number	:	808-965-0770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	05/23/2008

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Directions to “ MR. NICOLAS MYRIANTHIS PT” Practice Location

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