Provider Demographics
NPI:1104045525
Name:MOYER, BRIAN J (LMT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:MOYER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MONTROSE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3637
Mailing Address - Country:US
Mailing Address - Phone:614-562-9681
Mailing Address - Fax:
Practice Address - Street 1:226 MONTROSE WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3637
Practice Address - Country:US
Practice Address - Phone:614-562-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020346225700000X
OH33.016536-L-M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0212585OtherL&I PROVIDER