Healthcare Provider Details

I. General information

NPI: 1104045525
Provider Name (Legal Business Name): BRIAN J MOYER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MONTROSE WAY
COLUMBUS OH
43214-3637
US

IV. Provider business mailing address

226 MONTROSE WAY
COLUMBUS OH
43214-3637
US

V. Phone/Fax

Practice location:
  • Phone: 614-562-9681
  • Fax:
Mailing address:
  • Phone: 614-562-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020346
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.016536-L-M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: