Provider Demographics
NPI:1154415107
Name:MOYER, JESSICA VIETH (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:VIETH
Last Name:MOYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:HUBLEY
Other - Last Name:VIETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 CRESTHAVEN PLACE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:716-983-2931
Mailing Address - Fax:
Practice Address - Street 1:107 CRESTHAVEN PLACE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:716-983-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028678225100000X
FLPT23835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist