Provider Demographics
NPI:1730479395
Name:MOYNIHAN, JOANNA K (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:K
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:KAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1 CREDIT UNION WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-767-7531
Practice Address - Street 1:156 ANDOVER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1468
Practice Address - Country:US
Practice Address - Phone:978-767-8343
Practice Address - Fax:978-767-8349
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9604746OtherAETNA
MA1227803OtherASH/CIGNA
MA110089945AMedicaid
MA051773OtherOPTUM/UHC