Healthcare Provider Details

I. General information

NPI: 1437182045
Provider Name (Legal Business Name): SCOTT MOYNAHAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 N PIMA CENTER PKWY SUITE 101
SCOTTSDALE AZ
85258-8525
US

IV. Provider business mailing address

PO BOX 80217
PHOENIX AZ
85060-0217
US

V. Phone/Fax

Practice location:
  • Phone: 602-493-9361
  • Fax: 602-493-9508
Mailing address:
  • Phone: 602-385-2115
  • Fax: 480-481-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5698
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: