Provider Demographics
NPI:1699056739
Name:MOFFAT, JOEL KIRBY (LAT ATC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:KIRBY
Last Name:MOFFAT
Suffix:
Gender:M
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6668
Mailing Address - Street 2:100 ATHLETIC STREET
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-5119
Mailing Address - Country:US
Mailing Address - Phone:828-689-1124
Mailing Address - Fax:828-689-1313
Practice Address - Street 1:100 ATHLETIC ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-9134
Practice Address - Country:US
Practice Address - Phone:828-689-1124
Practice Address - Fax:828-689-1313
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer