Provider Demographics
NPI:1366939910
Name:MOYER, JAIMIE LYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:LYN
Last Name:MOYER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:LYN
Other - Last Name:BORCHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:730 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5211
Mailing Address - Country:US
Mailing Address - Phone:215-855-9871
Mailing Address - Fax:215-855-8748
Practice Address - Street 1:730 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5211
Practice Address - Country:US
Practice Address - Phone:215-855-9871
Practice Address - Fax:215-855-8748
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist