Healthcare Provider Details

I. General information

NPI: 1790256824
Provider Name (Legal Business Name): AMY LEE MOYE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S PENNSYLVANIA AVE
LANSING MI
48910-3495
US

IV. Provider business mailing address

6148 PLAINS RD
EATON RAPIDS MI
48827-9694
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-9900
  • Fax:
Mailing address:
  • Phone: 517-290-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502000811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: