Healthcare Provider Details

I. General information

NPI: 1326846940
Provider Name (Legal Business Name): MARIAH CHRISTINA MOYER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MARIETTA RD NW
ATLANTA GA
30318-3653
US

IV. Provider business mailing address

1500 MARIETTA RD NW STE 12
ATLANTA GA
30318-3653
US

V. Phone/Fax

Practice location:
  • Phone: 336-554-5324
  • Fax: 770-450-8944
Mailing address:
  • Phone: 336-554-5324
  • Fax: 770-450-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: