Provider Demographics
NPI:1659108504
Name:MYERS PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:MYERS PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:870-588-6072
Mailing Address - Street 1:1501 SULLIVAN CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9645
Mailing Address - Country:US
Mailing Address - Phone:870-283-4393
Mailing Address - Fax:
Practice Address - Street 1:1701 DISCIPLE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-7978
Practice Address - Country:US
Practice Address - Phone:870-588-6072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty