MEDICARE: MYERS INSTITUTE FOR FASCIAL MATRIX CONNECTION METHOD LLC

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1245715325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYERS INSTITUTE FOR FASCIAL MATRIX CONNECTION METHOD LLC

Provider Business Mailing Address
First Line	:	237 10TH ST LOWR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3501
Country	:	US
Telephone Number	:	610-781-0235
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 10TH ST LOWR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3501
Country	:	US
Telephone Number	:	610-781-0235
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	MR. MICHAEL DENNIS MYERS
Credential	:	LMT
Telephone Number	:	610-781-0235

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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