=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851046528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SJ MEYERS PT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2022
-----------------------------------------------------
Last Update Date | 02/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7559 GREAT OAK DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-7108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-602-6589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7559 GREAT OAK DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-7108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-602-6589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SAMANTHA MEYERS
-----------------------------------------------------
Credential | PT, DPT, CMPT
-----------------------------------------------------
Telephone | 561-602-6589
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------