Provider Demographics
NPI:1265718548
Name:MYERS, MICHAEL ROBERT (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:MYERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 FROG POND CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1244
Mailing Address - Country:US
Mailing Address - Phone:907-251-5472
Mailing Address - Fax:907-600-1823
Practice Address - Street 1:158 FROG POND CIR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-1244
Practice Address - Country:US
Practice Address - Phone:907-251-5472
Practice Address - Fax:907-600-1823
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist