Provider Demographics
NPI:1306815063
Name:MOYER, ASA (PT)
Entity Type:Individual
Prefix:
First Name:ASA
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S COURTLAND ST
Mailing Address - Street 2:# 101
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2827
Mailing Address - Country:US
Mailing Address - Phone:570-420-0606
Mailing Address - Fax:570-420-0646
Practice Address - Street 1:66 S COURTLAND ST
Practice Address - Street 2:# 101
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2827
Practice Address - Country:US
Practice Address - Phone:570-420-0606
Practice Address - Fax:570-420-0646
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012169L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12314120OtherMULTIPLAN
PA000461656OtherHIGHMARK BCBS
PA823493OtherFIRST PRIORITY HEALTH
PA096521Medicare PIN
PA12314120OtherMULTIPLAN