Provider Demographics
NPI:1366057317
Name:WALTHER-MOYER, KYM (LMT)
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:
Last Name:WALTHER-MOYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 HILDEBRANDT RD
Mailing Address - Street 2:
Mailing Address - City:PERKIOMENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18074-9340
Mailing Address - Country:US
Mailing Address - Phone:610-754-0044
Mailing Address - Fax:
Practice Address - Street 1:1246 COLLEGEVILLE RD
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-1947
Practice Address - Country:US
Practice Address - Phone:610-584-2439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG012376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist