Healthcare Provider Details

I. General information

NPI: 1467830182
Provider Name (Legal Business Name): ALEX MOYERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 NORTH POPLAR FORK ROAD
HURRICANE WV
25526-9434
US

IV. Provider business mailing address

2909 OVERLOOK DR
HUNTINGTON WV
25705-1039
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-2026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002096
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: