1881961928 NPI number — LAURA MICHELE MYERS P.T., D.P.T.

Table of content: LAURA MICHELE MYERS P.T., D.P.T. (NPI 1881961928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881961928 NPI number — LAURA MICHELE MYERS P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
LAURA
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUSCATELLO
Provider Other First Name:
LAURA
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881961928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 EAGLE ROCK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HANOVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07936-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-929-3351
Provider Business Mailing Address Fax Number:
973-887-3816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4253 ROUTE 9 N
Provider Second Line Business Practice Location Address:
BLDG 4 UNIT A
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-8309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-780-9033
Provider Business Practice Location Address Fax Number:
732-780-8680
Provider Enumeration Date:
11/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01425500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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