MEDICARE: ETHAN MOYER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1811856156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN MOYER PT

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 JFK BLVD STE 1820
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1725
Country	:	US
Telephone Number	:	215-454-2812
Fax Number	:	267-239-5027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ ETHAN MOYER PT” Practice Location

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