Provider Demographics
NPI:1033527627
Name:MOYER, KYLE JOHN (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JOHN
Last Name:MOYER
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 S WYOMISSING AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2537
Mailing Address - Country:US
Mailing Address - Phone:484-797-3519
Mailing Address - Fax:
Practice Address - Street 1:2601 GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1300
Practice Address - Country:US
Practice Address - Phone:610-678-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0059632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer