Provider Demographics
NPI:1124460415
Name:MOYO, NKOSI (LMT)
Entity type:Individual
Prefix:MR
First Name:NKOSI
Middle Name:
Last Name:MOYO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:NKOSIYABO
Other - Middle Name:
Other - Last Name:MOYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:485 HUNTINGTON RD
Mailing Address - Street 2:# 198
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-1861
Mailing Address - Country:US
Mailing Address - Phone:706-255-8822
Mailing Address - Fax:
Practice Address - Street 1:485 HUNTINGTON RD
Practice Address - Street 2:# 198
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1861
Practice Address - Country:US
Practice Address - Phone:706-255-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT 008444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist