Provider Demographics
NPI:1457471807
Name:MOYER, MARY B (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
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 1:3508 FAR WEST BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3080
Mailing Address - Country:US
Mailing Address - Phone:512-832-9411
Mailing Address - Fax:512-832-9401
Practice Address - Street 1:3508 FAR WEST BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3080
Practice Address - Country:US
Practice Address - Phone:512-832-9411
Practice Address - Fax:512-832-9401
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist