MEDICARE: MR. WILLIAM O MYERS JR.

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	MA96978	FL

General Provider Information

NPI Number	:	1902482086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM O MYERS JR.

Provider Business Mailing Address
First Line	:	6601 S WEST SHORE BLVD APT 1322
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-1511
Country	:	US
Telephone Number	:	813-394-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 S WEST SHORE BLVD APT 1322
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-1511
Country	:	US
Telephone Number	:	813-394-6476
Fax Number	:

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

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	03/19/2021

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