Provider Demographics
NPI:1962390443
Name:MEYERS, SHANE (PTA, BSPTA)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:MEYERS
Suffix:
Gender:M
Credentials:PTA, BSPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 310TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT EDWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68660-5236
Mailing Address - Country:US
Mailing Address - Phone:402-669-2189
Mailing Address - Fax:
Practice Address - Street 1:130 6TH ST
Practice Address - Street 2:
Practice Address - City:SCOTLAND
Practice Address - State:SD
Practice Address - Zip Code:57059-2111
Practice Address - Country:US
Practice Address - Phone:605-789-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1287225200000X
SD0631225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant