Provider Demographics
NPI:1073407466
Name:MOYER, RYAN GORDON (DR)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:GORDON
Last Name:MOYER
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 N CLAUDE A LORD BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2705
Mailing Address - Country:US
Mailing Address - Phone:570-516-9858
Mailing Address - Fax:
Practice Address - Street 1:2211 QUARRY DR STE E55
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1162
Practice Address - Country:US
Practice Address - Phone:610-860-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPT023983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist