Provider Demographics
NPI:1043589476
Name:MOYER, DEBRA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:MOYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:918 AUTUMN WOODS LN
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3226
Mailing Address - Country:US
Mailing Address - Phone:608-444-1218
Mailing Address - Fax:
Practice Address - Street 1:5605 RED OAK TRL
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8412
Practice Address - Country:US
Practice Address - Phone:608-838-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4291-242251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics