Provider Demographics
NPI:1255489639
Name:MOYNIHAN, WILLIAM A (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:MOYNIHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19007 61ST AVENUE NE #5
Mailing Address - Street 2:HPI
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6300
Mailing Address - Country:US
Mailing Address - Phone:360-435-8989
Mailing Address - Fax:360-403-8347
Practice Address - Street 1:19007 61ST AVENUE NE #5
Practice Address - Street 2:HPI
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6300
Practice Address - Country:US
Practice Address - Phone:360-435-8989
Practice Address - Fax:360-403-8347
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341877Medicaid
WA130974OtherDEPT LABOR & INDUSTRIES
S68718Medicare UPIN
WA130974OtherDEPT LABOR & INDUSTRIES