Healthcare Provider Details

I. General information

NPI: 1063865475
Provider Name (Legal Business Name): JODY LYNN MOYER M.S., RCEP, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HIGHLAND AVENUE HANOVER HOSPITAL
HANOVER PA
17331
US

IV. Provider business mailing address

38 BONNIEFIELD CIR
GETTYSBURG PA
17325-7825
US

V. Phone/Fax

Practice location:
  • Phone: 717-316-3488
  • Fax:
Mailing address:
  • Phone: 717-334-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT002483A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: