Provider Demographics
NPI:1851762892
Name:MOOSE, AMY JOY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JOY
Last Name:MOOSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:JOY
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:9108 STATE HIGHWAY 198
Mailing Address - Street 2:
Mailing Address - City:CONNEAUTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16406-2646
Mailing Address - Country:US
Mailing Address - Phone:814-587-2012
Mailing Address - Fax:
Practice Address - Street 1:9108 STATE HIGHWAY 198
Practice Address - Street 2:
Practice Address - City:CONNEAUTVILLE
Practice Address - State:PA
Practice Address - Zip Code:16406-2646
Practice Address - Country:US
Practice Address - Phone:814-587-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003010225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant