Provider Demographics
NPI:1639590334
Name:MOYER, BRENDAN (MT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1516
Mailing Address - Country:US
Mailing Address - Phone:484-560-3433
Mailing Address - Fax:
Practice Address - Street 1:513 E FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1516
Practice Address - Country:US
Practice Address - Phone:484-560-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003792173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist