Healthcare Provider Details

I. General information

NPI: 1962039610
Provider Name (Legal Business Name): ZACHARY MOYER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 CHESTER AVE APT 4C
PHILADELPHIA PA
19104-4585
US

IV. Provider business mailing address

4107 CHESTER AVE APT 4C
PHILADELPHIA PA
19104-4585
US

V. Phone/Fax

Practice location:
  • Phone: 484-513-6205
  • Fax:
Mailing address:
  • Phone: 484-513-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT027890
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: