Provider Demographics
NPI:1174759096
Name:MYERSLMT, WENDY ANNE (LMT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:MYERSLMT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 WILTSHIRE BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1446
Mailing Address - Country:US
Mailing Address - Phone:937-409-3627
Mailing Address - Fax:
Practice Address - Street 1:4770 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-2021
Practice Address - Country:US
Practice Address - Phone:937-409-3627
Practice Address - Fax:397-433-2884
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017262225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist