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NPI Code Detail

MEDICARE: MR. ANDREW JOSEPH MOFFATT MA, ATC, LAT

MEDICARE: MR. ANDREW JOSEPH MOFFATT MA, ATC, LAT
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
12255A2300XAthletic TrainerAL183FL

General Provider Information

NPI Number : 1265419667
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW JOSEPH MOFFATT MA, ATC, LAT
Provider Business Mailing Address
First Line : 531 CYGNET LN
Second Line :
City : DELAND
State : FL
Zip : 32724-3772
Country : US
Telephone Number : 386-822-5550
Fax Number :
Provider Business Practice Location Address
First Line : 3127 W INTERNATIONAL SPEEDWAY BLVD
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-1070
Country : US
Telephone Number : 386-258-9502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 12/06/2011

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