Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4291-24 | WI |
N | 2251P0200X | Physical Therapist - Pediatrics | 4291-24 | WI |
NPI | 1043589476 |
---|---|
Provider Name | Mrs. Debra Lynn Moyer |
First Address | Oregon, WI 53575-3226 |
Second Address | Mc Farland, WI 53558-8412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2011 |
Last Update Date | 13/12/2011 |