MEDICARE: DAVID R. MYERS LMP

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	MA00023291	WA

General Provider Information

NPI Number	:	1417135849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID R. MYERS LMP

Provider Business Mailing Address
First Line	:	6722 W KENNEWICK AVE
Second Line	:	SUITE B
City	:	KENNEWICK
State	:	WA
Zip	:	99336-1793
Country	:	US
Telephone Number	:	509-554-4167
Fax Number	:	866-300-0363

Provider Business Practice Location Address
First Line	:	6722 W KENNEWICK AVE
Second Line	:	SUITE B
City	:	KENNEWICK
State	:	WA
Zip	:	99336-1793
Country	:	US
Telephone Number	:	509-554-4167
Fax Number	:	866-300-0363

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	10/04/2011

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