Provider Demographics
NPI:1801583802
Name:MATHEWS, MORIAH LEE
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:LEE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:ADAMSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19501-0777
Mailing Address - Country:US
Mailing Address - Phone:223-246-1671
Mailing Address - Fax:
Practice Address - Street 1:918 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9794
Practice Address - Country:US
Practice Address - Phone:717-335-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG015151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist