Healthcare Provider Details

I. General information

NPI: 1891730701
Provider Name (Legal Business Name): DANI MICHELLE MOFFIT MA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 EDISON AVE
COLLINGSWOOD NJ
08108-3124
US

IV. Provider business mailing address

103 EDISON AVE
COLLINGSWOOD NJ
08108-3124
US

V. Phone/Fax

Practice location:
  • Phone: 856-854-5998
  • Fax:
Mailing address:
  • Phone: 856-854-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: