Provider Demographics
NPI:1366772170
Name:MEYERS, MARIAN L (PT)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:L
Last Name:MEYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9675 SNAKE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9350
Mailing Address - Country:US
Mailing Address - Phone:307-690-3847
Mailing Address - Fax:307-733-4308
Practice Address - Street 1:9675 SNAKE RIVER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9350
Practice Address - Country:US
Practice Address - Phone:307-690-3847
Practice Address - Fax:307-733-4308
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-796225100000X, 2251N0400X
2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics