MEDICARE: MEAGAN MARIE MOYER MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT018464	PA

General Provider Information

NPI Number	:	1225293756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN MARIE MOYER MPT

Provider Business Mailing Address
First Line	:	318 CARSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-4803
Country	:	US
Telephone Number	:	609-221-8053
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 CARSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-4803
Country	:	US
Telephone Number	:	609-221-8053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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