Healthcare Provider Details

I. General information

NPI: 1336055177
Provider Name (Legal Business Name): ELIZABETH MOY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 PROVIDENCE HWY
DEDHAM MA
02026-6804
US

IV. Provider business mailing address

173 LAKE SHORE RD APT 1
BRIGHTON MA
02135-6348
US

V. Phone/Fax

Practice location:
  • Phone: 857-444-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number89559
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: