Healthcare Provider Details

I. General information

NPI: 1124258330
Provider Name (Legal Business Name): TIMOTHY VICTOR MOXIE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37650 PROFESSIONAL CENTER DR SUITE 105A
LIVONIA MI
48154-1197
US

IV. Provider business mailing address

37650 PROFESSIONAL CENTER DR SUITE 105A
LIVONIA MI
48154-1197
US

V. Phone/Fax

Practice location:
  • Phone: 734-953-1745
  • Fax: 734-953-1743
Mailing address:
  • Phone: 734-953-1745
  • Fax: 734-953-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberL1541872
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: