Provider Demographics
NPI:1780164301
Name:MOYNAHAN, BERNICE LIM (PHYSICAL THERAPY)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:LIM
Last Name:MOYNAHAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:692 BEAR CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-3858
Mailing Address - Country:US
Mailing Address - Phone:407-542-3250
Mailing Address - Fax:407-542-3322
Practice Address - Street 1:697 BEAR CREEK CT
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-3646
Practice Address - Country:US
Practice Address - Phone:407-542-3250
Practice Address - Fax:407-542-3322
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist