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NPI Code Detail

MEDICARE: MYA EISENGA PTA

MEDICARE: MYA EISENGA PTA
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
1225200000XPhysical Therapy Assistant5502008961MI

General Provider Information

NPI Number : 1164353983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYA EISENGA PTA
Provider Business Mailing Address
First Line : 4045 W ROYAL DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-8965
Country : US
Telephone Number : 231-935-0900
Fax Number : 231-935-0312
Provider Business Practice Location Address
First Line : 4045 W ROYAL DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-8965
Country : US
Telephone Number : 231-935-0900
Fax Number : 833-471-4026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2026
Last Update Date : 05/28/2026

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Directions to “ MYA EISENGA PTA” Practice Location

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