Provider Demographics
NPI:1881600526
Name:MOYER, STEPHEN (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 GRAVEL PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18041-2132
Mailing Address - Country:US
Mailing Address - Phone:215-679-6485
Mailing Address - Fax:
Practice Address - Street 1:1040 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1952
Practice Address - Country:US
Practice Address - Phone:610-967-6466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0013811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist