Provider Demographics
NPI:1497856892
Name:MOFFITT, THOMAS (MED, ATC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 WHITE BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-1041
Mailing Address - Country:US
Mailing Address - Phone:610-566-1776
Mailing Address - Fax:610-566-6502
Practice Address - Street 1:106 S NEW MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5202
Practice Address - Country:US
Practice Address - Phone:610-566-1776
Practice Address - Fax:610-566-6502
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0030582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer