Healthcare Provider Details

I. General information

NPI: 1639590334
Provider Name (Legal Business Name): BRENDAN MOYER M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E FAIRVIEW ST
COOPERSBURG PA
18036-1516
US

IV. Provider business mailing address

513 E FAIRVIEW ST
COOPERSBURG PA
18036-1516
US

V. Phone/Fax

Practice location:
  • Phone: 484-560-3433
  • Fax:
Mailing address:
  • Phone: 484-560-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMSG003792
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: