Provider Demographics
NPI:1730368002
Name:MOYER, DEANNE SUE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:SUE
Last Name:MOYER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:SUE
Other - Last Name:COOKEROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 GARRON RD
Mailing Address - Street 2:
Mailing Address - City:M SPRINGS
Mailing Address - State:VT
Mailing Address - Zip Code:05757
Mailing Address - Country:US
Mailing Address - Phone:802-235-2810
Mailing Address - Fax:
Practice Address - Street 1:85 GARRON RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN SPRINGS
Practice Address - State:VT
Practice Address - Zip Code:05757
Practice Address - Country:US
Practice Address - Phone:802-235-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0410000441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant