Healthcare Provider Details

I. General information

NPI: 1639714371
Provider Name (Legal Business Name): MATTHEW GARRETT MYERS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 07/01/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 GALLATIN FARMERS AVE
BELGRADE MT
59714-9142
US

IV. Provider business mailing address

1481 N 25TH AVE APT 203
BOZEMAN MT
59718
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-7229
  • Fax:
Mailing address:
  • Phone: 901-359-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13395
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2312
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: