MEDICARE: MS. CRYSTAL RENEE MYERS

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	225100000X	Physical Therapist		FL

General Provider Information

NPI Number	:	1679093769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL RENEE MYERS

Provider Business Mailing Address
First Line	:	11595 PLEASANT CREEK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7563
Country	:	US
Telephone Number	:	904-571-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	11595 PLEASANT CREEK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7563
Country	:	US
Telephone Number	:	904-571-0709
Fax Number	:

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	07/21/2022

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