MEDICARE: THOMAS E MYERS 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
1	225200000X	Physical Therapy Assistant	5502002264	MI

General Provider Information

NPI Number	:	1295005619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS E MYERS PTA

Provider Business Mailing Address
First Line	:	PO BOX 487
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-0487
Country	:	US
Telephone Number	:	231-347-6636
Fax Number	:	231-347-2886

Provider Business Practice Location Address
First Line	:	1333 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-347-6636
Fax Number	:	231-347-2886

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

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	01/02/2012

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Directions to “ THOMAS E MYERS PTA” Practice Location

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