Healthcare Provider Details

I. General information

NPI: 1104879345
Provider Name (Legal Business Name): JEFFREY DAVID MOYER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6252 E BEVERLY LN
SCOTTSDALE AZ
85254-1355
US

IV. Provider business mailing address

6252 E BEVERLY LN
SCOTTSDALE AZ
85254-1355
US

V. Phone/Fax

Practice location:
  • Phone: 480-241-7701
  • Fax:
Mailing address:
  • Phone: 480-241-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5009
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5009
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number5009
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: