Healthcare Provider Details

I. General information

NPI: 1558024935
Provider Name (Legal Business Name): CAROLYN MOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 E HAVERFORD RD
BRYN MAWR PA
19010-3838
US

IV. Provider business mailing address

475 ALLENDALE RD STE 206
KING OF PRUSSIA PA
19406-1495
US

V. Phone/Fax

Practice location:
  • Phone: 610-557-0590
  • Fax:
Mailing address:
  • Phone: 610-270-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT029973
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: