Healthcare Provider Details

I. General information

NPI: 1780303495
Provider Name (Legal Business Name): DANA MOYER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 PIPER STATION DR STE 103
CHARLOTTE NC
28277-6690
US

IV. Provider business mailing address

2017 CENTRAL AVE APT 1102
CHARLOTTE NC
28205-5390
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-1616
  • Fax:
Mailing address:
  • Phone: 610-290-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: