Provider Demographics
NPI:1487740379
Name:MOY, MAUREEN LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:LYNN
Last Name:MOY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3430
Mailing Address - Country:US
Mailing Address - Phone:631-849-3143
Mailing Address - Fax:
Practice Address - Street 1:362 TYLER AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3430
Practice Address - Country:US
Practice Address - Phone:631-849-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 023996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist