Individual
ANDREA R MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4080 W BROADWAY AVE, 300, ROBBINSDALE, MN 55422-5604
(763) 533-0541
(763) 533-1052
Mailing address
PO BOX 9372, MINNEAPOLIS, MN 55440-9372
(763) 533-0541
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
051515
OH
225100000X
Physical Therapist
Primary
6287
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217253
ANTHEM BCBS
—
01
—
1427140755
NPI
—
01
—
2381515
MOLINA MEDICAID
OH
01
—
353666853-00
OH BUREAU WORKERS COMP
OH
01
—
650024753
RR MEDICARE
—
05
—
7303087000
—
WV
Enumeration date
09/28/2006
Last updated
07/10/2012
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