1245259688 NPI number — ROBERT R MYERS P.T.

Table of content: ROBERT R MYERS P.T. (NPI 1245259688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245259688 NPI number — ROBERT R MYERS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
ROBERT
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245259688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HATFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01088-9515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-247-6471
Provider Business Mailing Address Fax Number:
413-247-6474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 WEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HATFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-247-6471
Provider Business Practice Location Address Fax Number:
413-247-6474
Provider Enumeration Date:
07/18/2006

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:  5364 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 465532 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 650018717 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 626519 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y66164 . This is a "BCBS OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 788816 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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