Provider Demographics
NPI:1245086461
Name:MYERS, ETHAN JOHN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:JOHN
Last Name:MYERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W BURWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-9574
Mailing Address - Country:US
Mailing Address - Phone:330-432-0881
Mailing Address - Fax:
Practice Address - Street 1:2170 STUMBO RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1275
Practice Address - Country:US
Practice Address - Phone:419-756-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist