Provider Demographics
NPI:1083810691
Name:SPIES, MOIRA LYNNETTE
Entity Type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:LYNNETTE
Last Name:SPIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1124
Mailing Address - Country:US
Mailing Address - Phone:978-223-7717
Mailing Address - Fax:
Practice Address - Street 1:4 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1124
Practice Address - Country:US
Practice Address - Phone:978-223-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist