Provider Demographics
NPI:1225037526
Name:MOYER, ANNETTE LOUISE (PT)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:LOUISE
Last Name:MOYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:LOUISE
Other - Last Name:REBUCK-MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3405 POINCIANA AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1562
Mailing Address - Country:US
Mailing Address - Phone:610-929-5948
Mailing Address - Fax:610-488-8215
Practice Address - Street 1:7171 BERNVILLE RD
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-8624
Practice Address - Country:US
Practice Address - Phone:610-488-7854
Practice Address - Fax:610-488-8215
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000378E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA468220OtherBLUE SHIELD
PA01128401OtherBLUE CROSS
PA042372Medicare ID - Type Unspecified