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General NPI Number Information
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NPI Number | 1497417695
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Entity Type | Individual
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Provider Name | MORETA DON DYKE
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Gender | Female
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 450 ELLIS LN
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City | WEST CHESTER
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State | PA
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Zip | 19380-5123
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Country | US
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Telephone | 484-266-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 1236 E LANCASTER AVE APT 371
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City | DOWINGTOWN
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State | PA
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Zip | 19335
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Country | US
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Telephone | 814-369-7904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT007845
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License Number State | PA
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