Provider Demographics
NPI:1922235159
Name:MOFFETT, BYRON BRADFORD (DPT)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:BRADFORD
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 EAGLETREE LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7428
Mailing Address - Country:US
Mailing Address - Phone:256-883-0636
Mailing Address - Fax:256-883-0635
Practice Address - Street 1:1140 EAGLETREE LN SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7428
Practice Address - Country:US
Practice Address - Phone:256-883-0636
Practice Address - Fax:256-883-0635
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1922235159OtherAETNA
AL051599127OtherBCBS
AL102I657332Medicare PIN